Psychiatric Manifestations of HIV Infection and AIDS

Psychiatric Manifestations of HIV Infection and AIDS

Psychiatric Times November 2005
Issue 13

Patients with HIV infection are at risk of developing psychiatric symptoms
and disorders similar to those seen in the general population. Even before
infection, people at risk for HIV may come from certain populations--such as
injection-drug users and others with substance abuse or dependence--in whom
there is a higher than average risk for psychiatric illness (Pillard, 1988; Rounsaville et
al., 1982). Symptoms of anxiety and depression may be related to apprehension
about disease progression and death and sadness from the loss of health,
friends and income (Forstein, 1984; Nichols, 1985; Ostrow, 1987).

Several studies have found a substantial risk for DSM-III major depression and adjustment disorders with anxious or
depressed mood, which may occur during asymptomatic infection (Dilley et al.,
1985; Holland and Tross, 1985). In addition, patients
living with an underlying mental illness--especially severe and persistent
mental or mood disorders--are at a disproportionately increased risk of
developing infection with HIV due to sexual and substance use behaviors (Carey
et al., 2004).

HIV and the Brain

Shortly after the initial HIV infection, the virus enters the central
nervous system and may cause meningitis or encephalitis. Other serious CNS
complications tend to occur late in the course of disease, when immune function
has significantly declined, though studies have reported conflicting results as
to the predictive value of CD4 counts in assessing cognitive and motor
performance (Bornstein et al., 1991; Goethe et al., 1989; Koralnik
et al., 1990; McArthur et al., 1989; Miller et al., 1990; Saykin
et al., 1988). Viral load is more closely associated with the degree of
cognitive impairment. Patients with serum viral loads ≥30,000 copies/mL are 8.5 times more likely to develop dementia compared
to patients with viral loads <3,000 copies/mL
(Childs et al., 1999). In another study, a cerebrospinal fluid viral load >200
copies/mL was predictive of progression to
neuropsychological impairment (Ellis et al., 2002).

HIV-Associated Dementia

Patients infected with HIV are at risk of developing dementia as a direct
result of viral infection. This syndrome has been referred to by various names:
HIV-associated dementia complex (HAD)
(Working Group of the American Academy of Neurology AIDS Task Force, 1991), HIV encephalopathy, subacute encephalitis (Snider et al., 1983), AIDS encephalopathy and AIDS-dementia
(Navia et al., 1986b). HIV-associated
dementia is defined as acquired cognitive abnormalities in two or more domains
and is associated with functional impairment and acquired motor or behavioral
abnormalities, in the absence of another etiology (Table 1).


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