Associations Between HIV Disease and Mental Disorders

The causes of the various emotional, cognitive, and neurological concerns that can accompany HIV disease can be multifaceted and challenging to disentangle from each other and may include: [Fernandez 2010]

  • Mental disorders existing prior to becoming HIV-infected
  • Psychological stress associated with HIV diagnosis and treatment
  • HIV-related opportunistic infections or neoplasms, with potential nervous system effects
  • Adverse nervous system events associated with some antiretroviral agents (efavirenz being the most well-known example) [Sustiva PI]

In addition, HIV has long been known to directly infect cells of the brain and central nervous system (CNS) soon after initial HIV infection, with the potential for CNS impairment. [Ferrando 2008]

Effective management of HIV-infected patients requires coordination among several types of healthcare providers, including primary care physicians, infectious disease specialists, and mental health professionals. Among the key aspects of comorbid HIV disease and mental disorders are the following:

  • Mental disorders can increase the risk of acquiring or transmitting sexually transmitted diseases, including HIV. [Ramrakha 2000]
  • Mental disorders, including substance abuse, can predate and or complicate HIV-related illness. [Cournos 2001]
  • Mental disorders can affect adherence to HAART. [Farber 1999]
  • Some antiretroviral agents can affect the CNS and may be associated with psychiatric adverse events. [Tantisiriwat 1999]
  • Severely immune-compromised individuals—ie, those with advanced HIV disease—may be at particular risk for the HIV-related CNS complications that can cause acute mental status changes. [Álvarez-Segura 2008]
  • The proportion of mental health and/or substance abuse disorders among HIV-positive persons is nearly 5 times as great as that found in the general population. [Bing 2001]
  • Persons with a severe mental illness are disproportionately vulnerable (as high as 23%) to infection with HIV and other sexually transmitted infections. [Weiser 2004]
  • Mental disorders can be particularly challenging to diagnose accurately in an individual with concurrent medical illness. [Harold 1998]

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Howard University College of Medicine AIDS Education and Training Center - National Multicultural Center