Neuropsychiatric manifestations of HIV infection and AIDS

Neuropsychiatric manifestations of HIV infection and AIDS

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J Psychiatry Neurosci 2005;30(4):237-46

Benoit Dubé, MD; Tami Benton, MD; Dean G. Cruess, PhD; Dwight L. Evans, MD

Dubé, Benton, Cruess, Evans — Department of Psychiatry; Cruess — Department of Psychology and Pediatrics;
Evans — Departments of Medicine and Neuroscience, University of Pennsylvania, Philadelphia, Pa.

Abstract

As the life expectancy of people living with HIV infection has increased (through recent advances in antiretroviral therapy), clinicians have been more likely to encounter neuropsychiatric manifestations of the disease. Some patients present with cognitive deficits due to an HIVtriggered neurotoxic cascade in the central nervous system. However, more patients present with a depressive spectrum disorder during the course of their illness, the underlying pathogenesis of which is not as well understood. This category of psychiatric disorders presents diagnostic challenges because of the many neurovegetative confounding factors that are present in association with HIV illness. As quality of life becomes a more central consideration in the management of this chronic illness, better awareness of these neuropsychiatric manifestations is paramount. This article reviews these clinical issues and the available psychopharmacologic treatment options.

Résumé

Comme l’espérance de vie des personnes vivant avec le VIH a augmenté (grâce aux progrès récents de la thérapie aux antirétroviraux), les cliniciens sont maintenant plus susceptibles de faire face à des manifestations neuropsychiatriques de la maladie. Certains patients se présentent avec des déficits de la cognition attribuables à une cascade neurotoxique déclenchée par le VIH dans le système nerveux central. Plus de patients se présentent toutefois avec un trouble du spectre dépressif pendant leur maladie, dont on ne comprend pas aussi bien la pathogénèse sous-jacente. Cette catégorie de troubles psychiatriques pose des défis diagnostiques en raison des nombreux facteurs confusionnels neurovégétatifs associés à l’infection par le VIH. Comme la qualité de vie devient un facteur plus central dans la prise en charge de cette maladie chronique, il est primordial d’être plus conscient de ses manifestations neuropsychiatriques. Dans cet article, les auteurs passent en revue ces enjeux cliniques et les traitements psychopharmacologiques possibles.


Medical subject headings: HIV; acquired immunodeficiency syndrome; dementia; depression; bipolar disorder; psychopharmacology; psychoneuroimmunology.

Submitted Mar. 22, 2004; Revised Dec. 31, 2004; Accepted Feb. 1, 2005

Competing interests: None declared for Drs. Dubé, Benton and Cruess. Dr. Evans has received grants and/or research support from Cephalon, GlaxoSmithKline and the National Institute of Mental Health. He is on the speakers’ bureau for AstraZeneca, Eli Lilly, GlaxoSmithKline and Wyeth and has acted as a consultant with Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest Pharmaceuticals, Janssen Pharmaceutica, Novartis, Pfizer, Glaxo-SmithKline, Somerset and Wyeth.

Contributors: All authors contributed substantially to drafting and revising the article, and each gave final approval for the article to be published.

Correspondence to: Dr. Benoit Dubé, Assistant Professor of Clinical Psychiatry and Assistant Director, Office of Education, Department of Psychiatry, University of Pennsylvania, 3535 Market St., 2nd Floor, Philadelphia PA 19104; fax 215 746-7203; bedube@mail.med.upenn.edu