Abstract
VIH/AIDS infection is frequently associated with psychiatric disorders. Psychiatric comorbidities may interfere in adherence to antiretroviral treatment. Therefore, diagnosis and treatment of these conditions are essential. However, the administration of a new drug to the HAART therapy can result in drug interactions. Our objectives were to describe the relationship between mental disorders and HIV and to analyze the interactions and adverse reactions when combining psychotropic drugs and antiretrovirals. We aimed to review the literature of the association of mental disorders and HIV focusing mainly on the pharmacological aspects. We reviewed the English literature from 1993 until 2011 searching MEDLINE using interchangeably the key-words HIV, AIDS, psychosis, depression, anxiety, secondary mania, antidepressive agents, antipsychotics, benzodiazepines , and HAART. Patients with mental illnesses may be more prone to acquire infectious diseases by taking risk behaviors. Also, HIVinfected patients are more likely to present with psychiatric symptoms than the general population. Adding pharmacotherapy may improve adhesion to the antiretroviral treatment. We highlight the use of antipsychotics, antidepressants, benzodiazepines and mood stabilizers in patients diagnosed with HIV. We include interactions between pharmacotherapy and antiretroviraltherapy. Some of these drugs (e.g. Ritonavir) have shown important interactions, while others have shown any or no information was found available. Choosing the best therapeutic intervention in each case, particularly considering those drugs with the least interactions and adverse effects, is crucial for a therapeutic success and in the combat to infection.
Highlights
Background: HIV/AIDS infection is frequently associated with psychiatric disorders like psychosis, depression and anxiety
Psychiatric comorbidities may interfere with adherence to antiretroviral treatment
The administration of a psychotropic drug to highly active antiretroviral therapy (HAART) therapy can result in drug interactions
Summary
A MEDLINE search on anglo-saxonic literature was conducted, from 1993 until 2011, using the key-words: HIV, AIDS, psychosis, depression, anxiety, secondary mania, antidepressive agents, antipsychotics, benzodiazepines, HAART. A sertralina, além de eficaz no tratamento da depressão em doentes com VIH27,35 é uma escolha frequente por efeito inibitório mínimo no sistema enzimático que metaboliza os anti-retrovirais, com poucas interações medicamentosas[18]. A venlafaxina é uma escolha frequente por efeito inibitório mínimo no sistema enzimático que metaboliza os anti-retrovirais, com poucas interações medicamentosas[18,45]; porém, diminui os níveis plasmáticos de indinavir[27,32] e requer precaução se houver, entre outros, história de doença cardíaca ou de abuso de drogas[8]. O carbonato de lítio é o estabilizador do humor que tem menos potencial de ter interações específicas com anti-retrovirais[32], embora possa não ser bem tolerado, sobretudo nos estadios avançados da infecção VIH, com sinais e sintomas de toxicidade[15,18,45].
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