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cl:hiv [on September 16, 2018]
cl:hiv [on February 24, 2021] (current)
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 +====== Human Immunodeficiency Virus (HIV) ======
 +{{INLINETOC}}
 +===== Primer =====
 +**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 =====
 +  * 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.
 +
 +===== Comorbid Psychiatric Disorders =====
 +  * Stimulants such as dextroamphetamine and methylphenidate have been shown to be effective in treating depression in HIV-positive patients.[([[https://​pubmed.ncbi.nlm.nih.gov/​22303525/​|Ramasubbu,​ R., Taylor, V. H., Samaan, Z., Sockalingham,​ S., Li, M., Patten, S., ... & McIntyre, R. S. (2012). The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and select comorbid medical conditions. Ann Clin Psychiatry, 24(1), 91-109.]])]
 +===== Major or Mild Neurocognitive Disorder Due to HIV Infection =====
 +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.
 +
 +== Prevalence ==
 +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.
 +
 +<WRAP group>
 +<WRAP half column>
 +== Criterion A == 
 +The criteria are met for major or mild neurocognitive disorder.
 +== Criterion B == 
 +There is documented infection with human immunodeficiency virus (HIV).
 +</​WRAP>​
 +<WRAP half column>
 +== Criterion C == 
 +The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis.
 +== Criterion D ==
 +The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.
 +</​WRAP>​
 +</​WRAP>​
 +
 +===== Antiretrovirals =====
 +==== Efavirenz ====
 +  * 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.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​21484283|Kenedi,​ C. A., & Goforth, H. W. (2011). A systematic review of the psychiatric side-effects of efavirenz. AIDS and Behavior, 15(8), 1803-1818.]])] Efavirenz should be avoided in patients with a history of mental illness, such as schizophrenia.
 +
 +===== Pathophysiology =====
 +  * 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).