Neuropsychiatric Manifestations of HIV Infection and AIDS

Abstract

Acquired Immune Deficiency Syndrome (AIDS) was first reported in the United States in 1981 and has since become a major worldwide epidemic. AIDS is caused by the human immunodeficiency virus (HIV). By killing or damaging cells of the body’s immune system, HIV progressively destroys the body’s ability to fight infections and certain cancers. The term AIDS applies to the most advanced stages of HIV infection. Statistics on the world epidemic of HIV/AIDS indicates that 39.5 million people are living with HIV/AIDS worldwide. Of these, 24.7 million (63%) live in Sub-Saharan Africa, a region that is home to just 10% of the world’s population (UNAIDS/WHO report, 2006). HIV is a retrovirus, which is immunosuppressive, predisposing the individual to opportunistic infections and certain neoplasm (Wiley, 1994). In addition to impairment in immune functions, evidence has suggested that HIV is neurotropic. It should therefore be anticipated that neuropsychiatric complication might be common in HIV positive individuals during all phases of HIV related illness. Over the years, researchers have developed antiretroviral drugs to fight both HIV infection and its associated infections and cancers. Currently available drugs do not cure people with HIV infection or AIDS, and they all have side effects that can be severe. Because no vaccine for HIV is available, the only way to prevent infection is to avoid behaviours that put a person at risk of infection, such as sharing needles and unprotected sex. It is believed that neuropsychiatric disorders account for over 15% of the world’s disease burden. Due to the recent advances in antiretroviral therapy, the life expectancy of people living with HIV has increased, and thus clinicians are more likely to encounter the neuropsychiatric manifestations of the disease. In as many as 20% of HIV infected individuals, neurologic or neuropsychiatric symptoms may be the presenting features, prior to other medical symptoms of AIDS. Despite improvement in and combination of antiretroviral therapy, neuropsychiatric complications still occur in as many as 50% of people living with HIV and are mostly undiagnosed and untreated. Assessment and management of mental disorders is integral to an effective HIV/AIDS intervention program. Mental health professionals will increasingly be called upon to assist in the management of people living with HIV/AIDS. Thus psychiatrists will need to be familiar with disorders that are prevalent in HIV infection. It is now estimated that 40–70% of patients with AIDS develop clinical neurologic abnormalities. The most common neurologic manifestations are minor cognitive motor disorder (MCMD) and HIV-associated dementia (HAD). On the other hand, depression is the most common psychiatric condition in people living with