Human Immunodeficiency Virus (HIV)

Human Immunodeficiency Virus (HIV) is a lentivirus that causes HIV infection in humans, and over time develops into acquired immunodeficiency syndrome (AIDS). AIDS leads to progressive failure of the immune system and life-threatening opportunistic infections/cancers. HIV has numerous neuropsychiatric considerations, which are detailed below.

• Diagnosis of HIV is confirmed by established laboratory methods such as enzyme-linked immunosorbent assay for HIV antibody with Western blot confirmation and/or polymerase chain reaction-based assays for HIV.

• Stimulants such as dextroamphetamine and methylphenidate have been shown to be effective in treating depression in HIV-positive patients.^[1]

Some individuals with HIV infection will develop a neurocognitive disorder, which generally shows a “subcortical pattern” with prominently impaired executive function, slowing of processing speed, problems with more demanding attentional tasks, and difficulty in learning new information, but fewer problems with recall of learned information. In major neurocognitive disorder, slowing may be prominent. Language difficulties, such as aphasia, are uncommon, although reductions in fluency may be observed. HIV pathogenic processes can affect any part of the brain; therefore, other patterns are possible.

Depending on stage of HIV disease, approximately one-third to over one-half of HIV-infected individuals have at least mild neurocognitive disturbance, but some of these disturbances may not meet the full criteria for mild neurocognitive disorder. An estimated 25% of individuals with HIV will have signs and symptoms that meet criteria for mild neurocognitive disorder, and in fewer than 5% would criteria for major neurocognitive disorder be met.

• Efavirenz, a non-nucleoside analogue inhibitor of the reverse transcriptase, has become commonly used in highly active antiretroviral combination therapy in the treatment of HIV infection due to its ease of once daily dosing.
• However, there are early and serious side effects, such as acute psychosis resembling reactions to LSD intake, as well as nightmares occurring for several days up to 4 weeks after the start of therapy.^[2] Efavirenz should be avoided in patients with a history of mental illness, such as schizophrenia.

• HIV infects several types of cells, most particularly immune cells. Over time, the infection can cause severe depletion of “T-helper” (CD4) lymphocytes, resulting in severe immunocompromise, often leading to opportunistic infections and neoplasms. This advanced form of HIV infection is termed acquired immune deficiency syndrome (AIDS).