Overview of the neuropsychiatric aspects of HIV infection and AIDS
- Andrew A Pieper, MD, PhD
Andrew A Pieper, MD, PhD
- Investigator, The Harrington Discovery Institute
- Professor of Psychiatry
- Case Western Reserve University
- Glenn J Treisman, MD, PhD
Glenn J Treisman, MD, PhD
- Professor of Psychiatry and Behavioral Sciences, Professor of Medicine
- Johns Hopkins University School of Medicine
The high prevalence of neuropsychiatric disorders in individuals infected with the human immunodeficiency virus (HIV), is related to a wide variety of factors including: direct effects of the virus, preexisting psychiatric conditions, personality vulnerabilities, affective disorders, addictions, and personal responses to the social isolation and disenfranchisement associated with the diagnosis of HIV. Furthermore, many HIV-infected persons experience difficulty with treatment adherence due to their behavior patterns as well as acquisition of specific neuropsychiatric disorders associated with HIV disease progression. Studies have shown that patients with neuropsychiatric conditions have poorer outcomes and less benefit from antiretroviral therapy; however, psychiatric treatment improves HIV-related outcomes .
Neuropsychiatric care in HIV disease ranges from supportive psychotherapy for grief and loss issues to treatment of specific HIV-associated neuropsychiatric conditions (eg, HIV-associated dementia, minor cognitive-motor disorder, acquired immune deficiency syndrome [AIDS]-mania), as well as management of unique clinical presentations of other psychiatric disorders such as depression and schizophrenia. The availability of effective psychiatric care to HIV-infected patients is critical for their treatment and also for controlling the HIV epidemic.
Mental disorders that are commonly comorbid with HIV disease include:
●Minor cognitive-motor disorder (MCMD)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Himelhoch S, Moore RD, Treisman G, Gebo KA. Does the presence of a current psychiatric disorder in AIDS patients affect the initiation of antiretroviral treatment and duration of therapy? J Acquir Immune Defic Syndr 2004; 37:1457.
- McArthur JC, McClernon DR, Cronin MF, et al. Relationship between human immunodeficiency virus-associated dementia and viral load in cerebrospinal fluid and brain. Ann Neurol 1997; 42:689.
- Janssen RS, Cornblath DR, Epstein LG, et al. Human immunodeficiency virus (HIV) infection and the nervous system: report from the American Academy of Neurology AIDS Task Force. Neurology 1989; 39:119.
- van Servellen G, Chang B, Garcia L, Lombardi E. Individual and system level factors associated with treatment nonadherence in human immunodeficiency virus-infected men and women. AIDS Patient Care STDS 2002; 16:269.
- Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA 2001; 285:1466.
- Berger-Greenstein JA, Cuevas CA, Brady SM, et al. Major depression in patients with HIV/AIDS and substance abuse. AIDS Patient Care STDS 2007; 21:942.
- Colibazzi T, Hsu TT, Gilmer WS. Human immunodeficiency virus and depression in primary care: a clinical review. Prim Care Companion J Clin Psychiatry 2006; 8:201.
- Villes V, Spire B, Lewden C, et al. The effect of depressive symptoms at ART initiation on HIV clinical progression and mortality: implications in clinical practice. Antivir Ther 2007; 12:1067.
- Horberg MA, Silverberg MJ, Hurley LB, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr 2008; 47:384.
- Walkup J, Wei W, Sambamoorthi U, Crystal S. Antidepressant treatment and adherence to combination antiretroviral therapy among patients with AIDS and diagnosed depression. Psychiatr Q 2008; 79:43.
- Atkinson JH, Heaton RK, Patterson TL, et al. Two-year prospective study of major depressive disorder in HIV-infected men. J Affect Disord 2008; 108:225.
- Cournos F, Guido JR, Coomaraswamy S, et al. Sexual activity and risk of HIV infection among patients with schizophrenia. Am J Psychiatry 1994; 151:228.
- McKinnon K, Cournos F, Sugden R, et al. The relative contributions of psychiatric symptoms and AIDS knowledge to HIV risk behaviors among people with severe mental illness. J Clin Psychiatry 1996; 57:506.
- Kessler RC, Sonnega A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995; 52:1048.
- Najavits LM, Weiss RD, Shaw SR. The link between substance abuse and posttraumatic stress disorder in women. A research review. Am J Addict 1997; 6:273.
- Sher KJ, Trull TJ. Substance use disorder and personality disorder. Curr Psychiatry Rep 2002; 4:25.
- Mulder RT. Alcoholism and personality. Aust N Z J Psychiatry 2002; 36:44.
- Jacobsberg L, Frances A, Perry S. Axis II diagnoses among volunteers for HIV testing and counseling. Am J Psychiatry 1995; 152:1222.
- Johnson JG, Williams JB, Rabkin JG, et al. Axis I psychiatric symptoms associated with HIV infection and personality disorder. Am J Psychiatry 1995; 152:551.
- Perkins DO, Davidson EJ, Leserman J, et al. Personality disorder in patients infected with HIV: a controlled study with implications for clinical care. Am J Psychiatry 1993; 150:309.
- Weissman, MM. The epidemiology of personality disorders: a 1990 update. J Personal Disord 1993; 7 (suppl):44.
- Jung, C. Psychological Types, Harcourt Brace, New York 1923.
- Costa, PT Jr, Widiger, TA (Eds). Personality Disorders and the Five-Factor Model of Personality. American Psychological Association, Washington DC 1994.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- Tourian K, Alterman A, Metzger D, et al. Validity of three measures of antisociality in predicting HIV risk behaviors in methadone-maintenance patients. Drug Alcohol Depend 1997; 47:99.
- Eysenck, HJ. Genetic and environmental contributions to individual differences: the three major dimensions of personality. J Personality 1990; 58:245.
- Lucas RE, Diener E, Grob A, et al. Cross-cultural evidence for the fundamental features of extraversion. J Pers Soc Psychol 2000; 79:452.