Neuro-Psychiatric aspects of AIDS

January 26, 2015

AIDS (Acquired Immunodeficiency Syndrome) is a disease that compromises the body’s immune system, causing it to break down and rendering it unable to fight off infection. The HIV virus weakens the immune system, leaving the body vulnerable to infections and other illnesses, ranging from pneumonia to cancer. The consequences of HIV infection are not only physical; the diagnosis comes with the prospect of dealing with the stigma and social discrimination in the face of certain death. Its almost like being a death row victim, lonely and sad.

The high prevalence of neuropsychiatric disorders in individuals infected with the human immunodeficiency virus (HIV) is related to a wide variety of factors including: direct effects of the virus, preexisting psychiatric conditions, personality vulnerabilities, affective disorders, addictions, and personal responses to the social isolation and disenfranchisement associated with the diagnosis of HIV. Studies have shown that patients with neuropsychiatric conditions have poorer outcomes and less benefit from antiretroviral therapy; however, psychiatric treatment improves HIV-related outcomes.

Psycho-social aspects of HIV infection

The most common psychological problems associated with AIDS/HIV infection are feelings of acute emotional distress, depression, and anxiety, which can often accompany adverse life-events. Receiving an HIV diagnosis can produce strong emotional reactions. Initial feelings of shock and denial can turn to fear, guilt, anger, sadness, and a sense of hopelessness. Some people even have suicidal thoughts. It is understandable that one might feel helpless and fear illness, disability, and even death. Depression is twice as common in people with HIV as in the general population. Anxiety disorders too are common and may occur along with depression or as an isolated clinical entity. Substance abuse disorders are also widely seen as a result of underlying vulnerabilities or as a means to deal with anxiety and/or distress.

Neuropsychiatric aspects of HIV infection

CNS involvement in AIDS results from a variety of etiologies, including (a) the direct or primary effects of HIV-1 on nervous tissue, (b) the consequences of secondary viral and non viral opportunistic infections, tumors, and cerebrovascular disease, and (c) the complications of systemic therapies for AIDS and associated disorders. The manifestations range from cognitive (memory disturbance, attention deficits, dementia complex and delirium) to behavioral (psychosis, mood disorders etc.) symptoms.

Association of neuropsychiatric and psychosocial issues has consequences on management of the HIV infection. It impacts treatment compliance, may trigger off irresponsible behavior as a result of anger or frustration and may contribute to the growth of the epidemic. Thus identifying and treating these components of HIV infection is highly relevant in the treatment as well as prevention of the AIDS epidemic.