HIV and Psychiatry E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: WPA Series in Evidence and Experience in Psychiatry
• Sprache: Englisch

Seitenzahl: 543

Veröffentlichungsjahr: 2014

Beschreibung

Mental health and HIV/AIDS are closely interlinked.  Mental disorders, including substance-use disorders, are associated with increased risk of HIV infection and affect adherence to and efficacy of antiretroviral treatments.  Conversely, HIV infection can increase risk for neuropsychiatric complications including stress, mood, and neurocognitive disorders. 

This book provides clinicians with a comprehensive evidenced-based and practical approach to the management of patients with HIV infection and co-morbid mental disorders. It provides up-to-date and clear overviews of current clinical issues, as well as the relevant basic science.  Information and data from studies of different HIV groups (eg men who have sex with men) make the text relevant to a broad spectrum of clinicians, including those working with low socioeconomic status groups in high income countries and those working in the developing world.

The book uses the popular format of the World Psychiatric Association’s Evidence and Experience series.  Review chapters summarize the evidence on the epidemiology, pathogenesis and clinical aspects of mental disorders in HIV,and interventions (both psychotherapy and psychopharmacology including drug-drug interactions).  These are complemented by commentaries addressing particular facets of each topic and providing insight gained from clinical experience. 

Psychiatrists, psychologists and all mental health staff working with HIV-infected patients will find this book of great benefit.

Leseprobe

Table of Contents

Title Page

Series Page

Other recent World Psychiatric Association titles

Current Science and Clinical Practice Series

Copyright

List of Contributors

Preface

Chapter 1: Epidemiology of Psychopathology in HIV

THE CO-MORBIDITY AND IMPACT OF PSYCHIATRIC DISORDERS IN HIV INFECTION

HIV-ASSOCIATED NEUROCOGNITIVE DISORDERS

HIV-associated Delirium

ALCOHOL AND DRUG USE DISORDERS

MOOD AND ANXIETY DISORDERS

CONCLUSIONS

COMMENTARY: 1.1 Epidemiology of Psychopathology in HIV: Neurocognitive Disorders

INTRODUCTION

CLINICAL AND NEUROPSYCHOLOGICAL ASPECTS

EPIDEMIOLOGY OF HAND

SCREENING FOR HAND

IMPLICATIONS OF MILD FORMS OF HAND

AGEING AND HAND

REGIONAL DIFFERENCES IN HAND

COMMENTARY: 1.2 Depression and Anxiety Disorders in HIV/AIDS

CASE DEFINITION: SCREENING

CAUSATION AND DIAGNOSIS

PREVALENCE

RISK FACTORS AND ASSOCIATIONS

OUTCOME, CONCLUSIONS AND RECOMMENDATIONS

COMMENTARY: 1.3 Substance Use Disorders and HIV: Evolving Syndemics

EPIDEMIOLOGY OF SUBSTANCE ABUSE AMONGST PLWHA

IMPACT OF SUBSTANCE USE ON HIV-RELATED OUTCOMES

MARIJUANA: A RECREATIONAL OR MEDICINAL DRUG?

IMPLICATIONS FOR TREATMENT AND FUTURE DIRECTIONS

COMMENTARY: 1.4 Severe Mental Illness and HIV

INTRODUCTION

COMORBIDITY OF SEVERE MENTAL ILLNESS

AETIOLOGY OF SMI IN HIV

SEROPREVALENCE OF HIV IN SMI POPULATIONS

RISK BEHAVIOURS IN SMI

CLINICAL AND NEUROPSYCHOLOGICAL ASPECTS OF SMI

IMPACT OF SMI ON HEALTH OUTCOMES

Chapter 2: Pathogenesis of Mental Health Disorders in HIV

INTRODUCTION

PSYCHOSOCIAL AND BEHAVIOURAL RISK FACTORS

HIV BIOLOGY AND REPLICATION

CNS ENTRY AND NEUROBIOLOGY

HIV NEUROTOXICITY

HOST AND VIRAL GENETIC RISK FACTORS

AGEING AND HAND

CURRENT TREATMENTS AND FUTURE DIRECTIONS

CONCLUSION

COMMENTARY: 2.1 Behavioural and Social Risk Factors for HIV

INTRODUCTION

MULTILEVEL APPROACH TO THINKING ABOUT MENTAL DISORDERS AND HIV

MENTAL DISORDERS AND THE TRANSMISSION OF HIV INFECTION

POPULATION DISTRIBUTION OF MENTAL DISORDERS AND HIV

CONCLUSION

COMMENTARY: 2.2 Brain Imaging and Neuro-HIV

INTRODUCTION

NEUROIMAGING EVIDENCE OF WHITE MATTER AND BASAL GANGLIA DAMAGE

NEUROPATHOGENESIS AND HAND

COMORBID CONDITIONS EXACERBATE CNS EFFECTS

COMMON BRAIN ALTERATIONS IN AGEING AND HIV INFECTION

SUMMARY

COMMENTARY: 2.3 Host Genetics in HIV-Associated Neurocognitive Disorders

INTRODUCTION

APOLIPOPROTEIN E (ApoE)

CHEMOKINE RECEPTORS AND CYTOKINES

APOBEC

SUMMARY

COMMENTARY: 2.4 Traumatic Stressors and the Psychoneuroimmunology of HIV/AIDS

PSYCHOLOGICAL STRESSORS AND HIV/AIDS

PSYCHOBIOLOGY OF THE STRESS RESPONSE

IMPLICATIONS FOR INTERVENTION

CONCLUSION

Chapter 3: Clinical Aspects of HIV-Related Neurocognitive Disorders

INTRODUCTION

DEFINITION

EPIDEMIOLOGY

CLINICAL FEATURES

ASSESSMENT

INVESTIGATIONS

TREATMENT

SCREENING FOR HAND

FUTURE: HIV ERADICATION AND THE BRAIN

CONCLUSIONS

COMMENTARY: 3.1 Clinical Aspects of HIV-Related Neurocognitive Disorders

INTERACTIONS BETWEEN AGEING, ALZHEIMER'S PATHOLOGY AND HIV

DIFFERENCES BETWEEN HIV SUBTYPES AND HAND

DEFINING FUNCTIONAL IMPAIRMENT IN HAND

MEASUREMENT OF NEUROCOGNITIVE SYMPTOMS AS TREATMENT OUTCOME

COMMENTARY: 3.2 Differential Diagnosis in HIV-Associated Neurocognitive Disorders

HAND SIGNS AND SYMPTOMS IN THE ART-ERA

MODERN DIAGNOSTIC AND THERAPEUTIC MANAGEMENT OF HAND

LABORATORY TESTS

IMAGING PROCEDURES

CSF-ANALYSIS

NEUROPSYCHOLOGICAL TEST PATTERNS IN HAND

SCREENING FOR HAND

COMMENTARY: 3.3 Psychiatric Disorders and HIV

INTRODUCTION

THE CHANGING PICTURE OF HAND

SCREENING

MECHANISMS OF HAND

TREATMENT STRATEGIES

HAND AND MAJOR DEPRESSION

TREATING MAJOR DEPRESSION IN HAND

MENTAL HEALTH CARE IN COMORBID HAND

COMMENTARY: 3.4 Optimizing the Effectiveness of HIV Treatment as Prevention with Stimulant Users

Chapter 4: Treatment of Psychiatric Disorders in HIV

HIGHLY ACTIVE ANTIRETROVIRAL THERAPY FOR TREATING HIV-ASSOCIATED NEUROCOGNITIVE DISORDERS

ADJUVANT PHARMACOTHERAPIES FOR HIV-ASSOCIATED NEUROCOGNITIVE DISORDER

BEHAVIOURAL INTERVENTIONS FOR HIV-ASSOCIATED NEUROCOGNITIVE DISORDERS

INTERVENTIONS FOR PSYCHIATRIC DISORDERS IN HIV-INFECTED PEOPLE

BEHAVIOURAL AND OTHER PSYCHOTHERAPEUTIC APPROACHES

CONCLUSION

COMMENTARY: 4.1 Combination Anti-Retroviral Treatment and NeuroHIV

INTRODUCTION TO HIV-ASSOCIATED NEUROCOGNITIVE DISORDERS (HAND)

PERSISTENCE OF HAND IN CART ERA

CHALLENGES OF ADVANCING TREATMENTS FOR HAND

PRACTICAL CONSIDERATIONS FOR POTENTIAL TREATMENTS OF MOOD DISORDERS IN PATIENTS WITH AND WITHOUT HAND

COMMENTARY: 4.2 Psychopharmacology and Psychiatric Co-morbidity

TREATMENT OF HIV- ASSOCIATED NEUROCOGNITIVE DISORDERS (HAND)

PHARMACOTHERAPY FOR DEPRESSION AND PSYCHOTIC DISORDERS

DRUG INTERACTIONS AND OVERLAPPING TOXICITIES

ENSURING ACCESS AND EQUITY IN TREATMENT

COMMENTARY: 4.3 Intervention in HIV and Psychiatry: Behavioural and Psychotherapeutic Approaches

PSYCHIATRIC CO-MORBIDITIES AND HIV

MENTAL HEALTH AND HIV TRANSMISSION

THE PSYCHIATRIC BURDEN OF LIVING WITH HIV

PSYCHIATRIC ILLNESS AND ADHERENCE TO ART

BEHAVIOURAL INTERVENTIONS FOR ART ADHERENCE

MANAGING PSYCHIATRIC ILLNESS IN THE CONTEXT OF HIV

Chapter 5: Special Populations and Public Health Aspects

SPECIAL POPULATIONS IN THE HIV EPIDEMIC: AN OVERVIEW

MENTAL DISORDERS AMONGST SPECIAL POPULATIONS AT RISK FOR OR INFECTED WITH HIV

MEN WHO HAVE SEX WITH MEN (MSM)

PEOPLE WHO INJECT DRUGS (PWID)

SEX WORKERS

OVERLAP AMONGST KEY POPULATIONS

THE GENERALIZED EPIDEMIC IN SUB-SAHARAN AFRICA

PEOPLE WITH SEVERE MENTAL ILLNESS (SMI)

PROGRAM DEVELOPMENT IN THE HIV EPIDEMIC: AN OVERVIEW

ADDRESSING MENTAL DISORDERS: A GAP IN OUR APPROACHES TO HIV PREVENTION, CARE AND TREATMENT

MODELS FOR MENTAL HEALTH SERVICES FOR PEOPLE AT RISK OF OR LIVING WITH HIV/AIDS

FLEDGLING APPROACHES TO TREATING MENTAL DISORDERS AMONGST PEOPLE WITH HIV: RESEARCH FINDINGS AND SERVICES IMPLEMENTATION

CONCLUSIONS

COMMENTARY: 5.1 COMMENTARY Mental Health Services for HIV in Resource-Limited Settings

INTRODUCTION

DEVELOPING MENTAL HEALTH SERVICES FOR HIV IN RESOURCE-LIMITED SETTINGS

HEALTH SYSTEM STRATEGIES TO IMPROVE DELIVERY

CONCLUSION

COMMENTARY: 5.2 COMMENTARY Specifying the Mental Health Context for the Development of HIV Prevention and Treatment Interventions for Men Who Have Sex with Men

INTRODUCTION

INTEGRATED TREATMENT PLATFORMS

TREATMENT UTILIZATION AND ACCESSIBILITY

CONCLUSIONS

COMMENTARY: 5.3 Following the Special Populations Home: Children and Families

INTRODUCTION

IMPACTS OF HIV/AIDS: AIDS-ORPHANHOOD:

IMPACTS OF HIV/AIDS: PARENTAL ILLNESS

IMPACTS OF HIV/AIDS: HIV-POSITIVE CHILD STATUS

MECHANISMS OF DISTRESS IN CHILDREN

STIGMA AND POVERTY IN CHILDREN LIVING WITH FAMILY HIV

PARENT–CHILD RELATIONSHIPS AND DISTRESS

PSYCHOLOGICAL DISTRESS IN CHILDREN AND HEALTH OUTCOMES

REDUCING PSYCHOLOGICAL DISTRESS IN CHILDREN

CONCLUSIONS

COMMENTARY: 5.4 Gender Issues and the Burden of Disease in Women

INTRODUCTION

IPV, SEXUAL VIOLENCE and HIV

IPV, SEXUAL VIOLENCE AND MENTAL HEALTH DISORDERS

IMPLICATIONS FOR INTERVENTIONS

Index

Other recent World Psychiatric Association titles

Series Editor: Michelle Riba, WPA Secretary for Publications, Department of Psychiatry, University of Michigan

Special Populations

Clinical Psycho-Oncology: An International Perspective

Luigi Grassi and Michelle Riba

ISBN: 978-0-470-97432-2

Psychiatry and Heart Disease: The Mind, Brain, and Heart

Edited by Michelle Riba, Lawson Wulsin, Melvyn Rubenfire

ISBN: 978-0-470-68580-8

The Mental Health of Children and Adolescents: an area of global neglect

Edited by Helmut Remschmidt, Barry Nurcombe, Myron L. Belfer, Norman Sartorius and Ahmed Okasha

ISBN: 9780470512456

Contemporary Topics in Women's Mental Health: global perspectives in a changing society

Edited by Prabha S. Chandra, Helen Herrman, Marianne Kastrup, Marta Rondon, Unaiza Niaz, Ahmed Okasha, Jane Fisher

ISBN: 9780470754115

Parenthood and Mental Health: A bridge between infant and adult psychiatry

Edited by Sam Tyano, Miri Keren, Helen Herrman, John Cox

ISBN: 9780470747223

Depression and Diabetes

Edited by Wayne Katon, Mario Maj and Norman Sartorius

ISBN: 9780470688380

Depression and Heart Disease

Edited by Alexander Glassman, Mario Maj and Norman Sartorius

ISBN: 9780470710579

Depression and Cancer

Edited by David W. Kissane, Mario Maj and Norman Sartorius

ISBN: 9780470689660

Approaches to Practice and Research

Community Mental Health: Putting Policy Into Practice Globally

Edited by Graham Thornicroft, Atalay Alem, Robert E. Drake, Hiroto Ito, Jair Mari, Peter McGeorge, R. Tara, Maya Semrau

ISBN: 9781119998655

Religion and Psychiatry: beyond boundaries

Edited by Peter J Verhagen, Herman M van Praag, Juan José López-Ibor, John Cox, Driss Moussaoui

ISBN: 9780470694718

Psychiatric Diagnosis: challenges and prospects

Edited by Ihsan M. Salloum and Juan E. Mezzich

ISBN: 9780470725696

Recovery in Mental Health: reshaping scientific and clinical responsibilities

By Michaela Amering and Margit Schmolke

ISBN: 9780470997963

Handbook of Service User Involvement in Mental Health Research

Edited by Jan Wallcraft, Beate Schrank and Michaela Amering

ISBN: 9780470997956

Psychiatrists and Traditional Healers: unwitting partners in global mental health

Edited by Mario Incayawar, Ronald Wintrob and Lise Bouchard,

ISBN: 9780470516836

Current Science and Clinical Practice Series

Series Editor: Michelle Riba, WPA Secretary for Publications, Department of Psychiatry, University of Michigan

Obsessive Compulsive Disorder

Edited by Joseph Zohar

ISBN: 9780470711255

Schizophrenia

Edited by Wolfgang Gaebel

ISBN: 9780470710548

Evidence and Experience in Psychiatry Series

Series Editor: Michelle Riba, WPA Secretary for Publications, Department of Psychiatry, University of Michigan

HIV and Psychiatry

Edited by John A. Joska, Dan J. Stein and Igor Grant

ISBN: 9781118339541

Post-Traumatic Stress Disorders

Edited by Dan Stein, Matthew Friedman and Carlos Blanco

ISBN: 9780470688977

Substance Abuse Disorders

Edited by Hamid Ghodse, Helen Herrman, Mario Maj and Norman Sartorius

ISBN: 9780470745106

Depressive Disorders, 3e

Edited by Helen Herrman, Mario Maj and Norman Sartorius

ISBN: 9780470987209

Schizophrenia 2e

Edited by Mario Maj, Norman Sartorius

ISBN: 9780470849644

Dementia 2e

Edited by Mario Maj, Norman Sartorius

ISBN: 9780470849637

Obsessive-Compulsive Disorders 2e

Edited by Mario Maj, Norman Sartorius, Ahmed Okasha, Joseph Zohar

ISBN: 9780470849668

Bipolar Disorders

Edited by Mario Maj, Hagop S Akiskal, Juan José López-Ibor, Norman Sartorius

ISBN: 9780471560371

Eating Disorders

Edited by Mario Maj, Kathrine Halmi, Juan José López-Ibor, Norman Sartorius

ISBN: 9780470848654

Phobias

Edited by Mario Maj, Hagop S Akiskal, Juan José López-Ibor, Ahmed Okasha

ISBN: 9780470858332

Personality Disorders

Edited by Mario Maj, Hagop S Akiskal, Juan E Mezzich

ISBN: 9780470090367

Somatoform Disorders

Edited by Mario Maj, Hagop S Akiskal, Juan E Mezzich, Ahmed Okasha

ISBN: 9780470016121

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Library of Congress Cataloging-in-Publication Data

HIV and psychiatry : evidence and experience / edited by John A. Joska, Dan J. Stein, Igor Grant.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-118-33954-1 (pbk. : alk. paper)

I. Joska, John A., 1969- editor of compilation. II. Stein, Dan J., editor of compilation. III. Grant, Igor, 1942– editor of compilation.

[DNLM: 1. HIV Infections–psychology. 2. HIV Infections–physiopathology. WC 503.7]

RC606.6

616.97′920651–dc23

2013037721

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: Artist: Fauzia, Kenya, 2006; Reprinted with permission from Art2Be [www.art2bebodymaps.com]

Cover design by Cyan Design

List of Contributors

Naeemah Abrahams

Gender and Health Unit, South African Medical Research Council, Cape Town, South Africa

Gabriele Arendt

Department of Neurology, University of Duesseldorf, Duesseldorf, North Rhine-Westphalia, Germany

J. Hampton Atkinson

HIV Neurobehavioral Research Program, School of Medicine, University of California, San Diego, CA, USA

VA San Diego Healthcare System, San Diego, CA, USA

Chad A. Bousman

Department of Psychiatry, Melbourne Brain Centre, The University of Melbourne, Parkville, Victoria, Australia

Mark Boyes

Department of Social Policy and Intervention, University of Oxford, Oxford, UK

School of Psychology and Speech Pathology, Curtin University, Perth, Australia

Bruce J. Brew

Departments of Neurology and Immunology-Infectious Diseases, St Vincent's Hospital, St Vincent's Centre for Applied Medical Research St Vincent's Hospital, University of New South Wales, Sydney, New South Wales, Australia

Adam W. Carrico

Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA

Gursharan Chana

Department of Psychiatry, Melbourne Brain Centre, The University of Melbourne, Parkville, Victoria, Australia

Lucie Cluver

Department of Social Policy & Intervention, Oxford University, Oxford, UK

Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa

Francine Cournos

Mailman School of Public Health, Columbia University, New York, NY, USA

Nicholas W.S. Davies

Department of Neurology, Chelsea & Westminster Hospital, London, UK

Nichole A. Duarte

Clinical Research Department, Sharp Mesa Vista Hospital, San Diego, CA, USA

HIV Neurobehavioral Research Program, University of California, San Diego, CA, USA

Ian P. Everall

Department of Psychiatry, Melbourne Brain Centre, The University of Melbourne, Parkville, Victoria, Australia

Christine Fennema-Notestine

Department of Psychiatry and Radiology, University of California, San Diego, La Jolla, CA, USA

Maria Ferrara

Department of Mental Health and Substance Abuse, Modena, Italy

Igor Grant

Department of Psychiatry, University of California, San Diego, CA, USA

Mark Halman

Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Jodi Heaps

University of Missouri, St. Louis, MO, USA

John A. Joska

Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa

Malega Kganakga

HIV & AIDS, National Department of Social Development, South Africa

Adam F. Knight

HIV Neurobehavioral Research Program, University of California, San Diego, CA, USA

Wenxue Li

National Institutes of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA

Crick Lund

Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa

Jessica F. Magidson

Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, USA.

Department of Psychology, University of Maryland, College Park, MD, USA

Catherine Mathews

Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa

Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

Karen McKinnon

New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, New York, NY, USA

Christina S. Meade

Department of Psychiatry & Behavioral Sciences, Division of Medical Psychology, School of Medicine, Duke Global Health Institute, Durham, NC, USA

David J. Moore

HIV Neurobehavioral Research Program, University of California, San Diego, CA, USA

Seggane Musisi

Department of Psychiatry, School of Medicine, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda

Landon Myer

Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa

Etheldreda Nakimuli-Mpungu

Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda

Butabika National Referral Mental Hospital, Kampala, Uganda

Avindra Nath

National Institutes of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA

Conall O'Cleirigh

Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

The Fenway Institute, Fenway Health, Boston, MA, USA

Mark Orkin

School of Public and Development Management, University of the Witwatersrand, Johannesburg, South Africa

Robert Paul

Department of Psychology, University of Missouri, St. Louis, MO, USA

Veronica Pinho

New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, New York, NY, USA

Robert H. Remien

HIV Center for Clinical and Behavioral Studies

New York State Psychiatric Institute.

Department of Psychiatry, Columbia University, USA.

Reuben N. Robbins

HIV Center for Clinical and Behavioral Studies

New York State Psychiatric Institute.

Department of Psychiatry, Columbia University, USA.

Ned Sacktor

Johns Hopkins University School of Medicine, Baltimore, MD, USA

Giovanni Schifitto

University of Rochester, Rochester, NY, USA

Lorraine Sherr

Royal Free and University College Medical School, University College, London, UK

Kathleen J. Sikkema

Department of Psychology and Neuroscience, and Duke Global Health Institute, Duke University, Durham, NC, USA

Bryan Smith

Johns Hopkins University School of Medicine, Baltimore, MD, USA

Dan J. Stein

Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa

Sheri L. Towe

Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA

Duke Global Health Institute, Durham, NC, USA

Glenn Treisman

Johns Hopkins University School of Medicine, Baltimore, MD, USA

Ignacio P. Valero

HIV Unit, Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain

Charles Venuto

University of Rochester, Rochester, NY, USA

Milton Wainberg

New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, New York, NY, USA

Preface

The HIV/AIDS epidemic, now in its fourth decade, remains a major public health challenge. Major strides were made in the first two decades in terms of describing the neurologic effects of the virus, and the importance of combining antiretroviral agents in achieving adequate clinical outcomes. Substantial efforts in recent years have seen how the brain may be affected early in infection, how the blood brain barrier may restrict treatment effects, and how co-occurring substance abuse, depression and other mental disorders may impact on functional impairment.

This book represents an attempt to draw together current knowledge from a truly global set of experts on how HIV affects the brain and mind. These authors set about explaining mechanisms of neuro- and psychopathology, its manifestations and its treatment. The impact of HIV is not limited to neurocognitive effects: comorbid psychiatric disorders add complexity to the assessment and treatment of people living with HIV/AIDS. Our knowledge of these is only partial at this time.

In the absence of treatment, the characteristic brain effects of HIV follow the subcortical pattern of infection, with memory impairment, slowing and apathy. With the advent of antiretroviral therapy (ART), a different spectrum of neurocognitive deficits, including cortical problems, can be detected. Our knowledge of the effects of HIV on the brain has grown exponentially through neuroimaging, biomarker and cerebrospinal fluid (CSF) studies. Despite these advances, many individuals with HIV-associated brain disease remain impaired, with evidence of ongoing or persistent disease. We therefore have included commentaries providing up-to-date insights into these issues.

The psychiatric disorders associated with HIV arise from the varying combinations of the biologic effects of HIV on the brain, underlying host genetic vulnerability factors, treatment effects and the psycho-social environment. Indeed, people living with HIV (PLWH) may face several unique psycho-social stresses, including the stigma of living with HIV, bereavement and multiple medical comorbidity. We have invited the contributors to include information on how psychiatric disorders may co-occur with neurologic manifestations of HIV. Particularly, we wanted to illustrate how frequently these disorders exist in PLWH; how they may arise in the context of untreated and treated HIV infection; and how different groups, including men who have sex with men, women and children, may be uniquely impacted.

The neurocognitive and psychiatric manifestions of HIV infection share many common features throughout the world. But there are also differences. These include the viral sub-types, which may impart unique neurovirulence; but also patterns of substance misuse, rates of coinfection and gender distribution. The impact of social factors, including resource limitations and access to ART remain key issues. We have sought to present a global view of HIV/AIDS and psychiatry, whilst including specific references to regional influences.

In attempting to lay out these problems, we have used the format of Wiley's Evidence and Experience series, published in collaboration with the World Psychiatric Association. There are five sections, which link developmentally with each other. These section authors have provided comprehensive state-of-the art reviews on the epidemiology, aetiology, clinical features and treatment of psychiatric disorders in HIV. The final section provides a key exposition of special groups of individuals affected by HIV, such as women and children, and men who have sex with men. Each section is then followed by a series of shorter commentaries. The commentators provide perspectives and fresh insights from additional angles.

We are grateful to the authors of both the review chapters and commentaries for their work, and to Joan Marsh and Wiley for encouraging this volume.

John A. JoskaCape Town, South Africa

Dan J. SteinCape Town, South Africa

Igor GrantSan Diego, CA, USA

Chapter 1

Epidemiology of Psychopathology in HIV

Milton L. Wainberg1, Karen McKinnon1, and Francine Cournos2

1New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, USA

2Mailman School of Public Health, Columbia University, USA

THE CO-MORBIDITY AND IMPACT OF PSYCHIATRIC DISORDERS IN HIV INFECTION

The HIV epidemic has been called ‘an unprecedented reversal of human health progress’ [1]. Psychiatric or mental disorders are common co-morbidities amongst people at risk for or infected by HIV, and the epidemic will not be adequately controlled, even with treatment as prevention, unless these co-occurring disorders are addressed. Consistent with the diagnostic approaches of both the Diagnostic and Statistical Manual of Mental Disorders DSM-V and International Classification of Diseases ICD-10 of the World Health Organization, we use the terms ‘mental disorders’ and ‘psychiatric disorders’ to include substance use diagnoses, other mental illnesses, and neurocognitive impairment.

Mental and substance use disorders are the leading cause of years lived with disability (YLDs) worldwide [2]. Effects of mental disorders are magnified by their propensity to increase the risk for communicable and non-communicable diseases and by their contribution to unintentional and intentional injury [3]. Further, health conditions such as diabetes, coronary artery disease and infection with HIV increase the risk for mental disorders, and co-morbidity complicates help-seeking, diagnosis, treatment and prognosis [3–6]. Mental disorders are associated with the acquisition and transmission of HIV and other sexually transmitted infections, reduced coping capacity at the time of HIV diagnosis, poor HIV-related disease prognosis, failure to access HIV care and treatment, erratic adherence to antiretroviral regimens, diminished quality of life, greater social burden, increased health-care costs and higher mortality [7–13].