HIV Flashcards
What demographics are at highest risk for HIV?
White British homosexuals and African female heterosexuals
What are the initial signs of HIV infection?
Asymptomatic or minor cold symptoms
What conditions are associated with direct invasion of the brain by HIV?
▪️HIV encephalopathy
▪️AIDS dementia complex
When do neuropsychiatric symptoms usually occur in HIV?
In later stages when profound immunosuppression have occurred
(very low CD4)
What other causes of neuropsychiatric symptoms could be considered in someone with HIV?
Coincident active opportunistic infections (e.g. toxoplasmosis)
What is CD4?
A type of white blood cell used as a marker of immune function
What is normal CD4?
> 1,000
How does CD4 change across HIV infection?
Drops initially to fight it then bounces back up as you become a carrier. It then gradually decreases again as it wears down your immune system.
What happens as your CD4 gets lower?
You become immunocompromised and are more susceptible to other infections and the entry of these into the brain.
If CD4 becomes very low (~100), how much can CD4 be improved with treatment?
Normally only to around 500
(immune system is still 50% down)
What are some of the early neuropsychiatric symptoms of HIV infection?
▪️Memory difficulties
▪️Concentration difficulties
▪️Apathy
▪️Mood disturbance
▪️General mental slowing preceding specific deficits
What behavioural changes may be apparent with HIV infection?
▪️Apathy
▪️Social withdrawal
▪️Agitation
▪️Anxiety
▪️Irritability
▪️Emotional lability
What acute signs may indicate active HIV infection in the brain?
▪️Organic psychosis-like features (hallucinations, delusions)
▪️Motor dysfunction (poor balance, weakness, worse handwriting)
Without treatment, how quickly do neuropsychiatric symptoms deteriorate into a severe state?
Usually within months but may be longer
What condition may occur at extremely low levels of immunity in HIV?
Progressive multifocal leukoencephalopathy
What is progressive multifocal leukoencephalopathy?
A disease of the CNS resulting in destruction of the myelin sheath and diffuse white matter damage
How might PML present on a CT scan?
Low density lesions with ‘scalloped’ edges
What are the symptoms of PML?
▪️Rapidly progressive dementia
▪️Motor difficulties such as paresis, ataxia, and dysphagia
What is the prognosis of PML?
Usually very poor but improving. Some people can make a full recovery
Is there a relationship between cognitive performance and immunity in asymptomatic HIV positive subjects?
No
What type of dementia is HIV dementia most similar to?
Parkinson’s dementia
Is there a relationship between HIV and other psychiatric diagnoses?
No, although depressive symptoms in those with HIV may show improvement associated with improvement in physical HIV symptoms
Which other populations have shown increased rates of HIV infection compared to the general population?
▪️Psychiatric inpatients
▪️Homeless people
▪️Individuals with schizophrenia
What neuropsychiatric side effect has been associated with interferon for treatment of Hepatitis C?
Depression
What are the main types of HIV medication?
▪️Nucleoside reverse transciptase inhibitors
▪️Non-nucleoside reverse transciptase inhibitors
▪️Protease inhibitors
What side effects have been associated with nucleoside reverse transciptase inhibitors?
Abnormal dreams and depression
What side effects have been associated with non-nucleoside reverse transciptase inhibitors?
Abnormal dreams, sleep disturbance, fatigue, depression, psychosis, suicidal ideation
What side effects have been associated with protease inhibitors?
Sleep disturbance, drowsiness, fatigue, anxiety
What is the main difference between the three types of HIV medication?
They target different points in the progression of HIV
What class of drugs show interactions with HIV medication?
Psychotropics, particularly benzodiazepines and some antipsychotics
What side effect may be seen with the interaction of HIV medication and benzodiazepines?
Excessive sedation
What type of antidepressant is most likely to interact with HIV medication?
Tricyclic
Which antipsychotic has a high incidence of adverse effects in HIV?
Chlorpromazine
How do psychotropics typically interact with HIV medication?
via cytochrome P450 enzymes
What type of antipsychotic is preferred for someone with HIV?
Atypical antipsychotics (e.g. Olanzapine, risperidone) at lower than normal doses
What HIV medication side effects may be exacerbated by antipsychotics?
▪️Lipodystrophy
▪️Impaired glucose metabolism
Is poorly controlled HIV associated with greater fatigue?
No!
Fatigue levels are more associated with psychological factors
