HIV

Question 1

How does HIV cause mental illness x4

Answer 1

Anxiety
Toxins
Opportunistic infections
Drug side effects- efavirenz

Question 2

How does mental illness cause HIV x4

Answer 2

Impulsive disorders
High risk behaviors
Abuse or vulnerability
Inability to negotiate for safe sex

Question 3

Mental health disorders of public health concern x3

Answer 3

Depression
Substance use
Neurocognitive disorders

Question 4

Risk factors of mental illness in HIV x3

Answer 4

Genetic predisposition
Use of isoniazid
Low BMI

Question 5

Ways in which HIV can enter CNS x3

Answer 5

Infected macrophages
Damaged/inflamed tight junctions
Damaged/inflamed blood brain barrier

Question 6

Describe what happens during neuro excitotoxicity x5

Answer 6

HIV viral proteins affect reuptake of dopamine and glutamate > prolonged neuronal stimulation, increased intracellular calcium, synaptic degeneration > damaged BG and nigrostriatal structures

Question 7

State the 3 HIV associated neurocognitive disorders HAND

Answer 7

Asymptomatic neurocognitive impairment
Mild neurocognitive impairment
HIV associated dementia

Question 8

Examples of cortical x2 and subcortical features x2 of HAD

Answer 8

Cortical - amnesia, aphasia, apraxia
Subcortical - distal weakness, gait abnormalities

Question 9

Diagnostic criteria for HIV neurocognitive disorder x4

Answer 9

A- criteria met for major and minor neurocognitive disorder
B- documentation of HIV infection
C- ND not explained by non HIV conditions
D- ND not attributable to another medical condition

Question 10

Progression of HIV associated dementia x4

Answer 10

Mutism
Immobility
Double incontinence
Death

Question 11

Biological management of HAND x3

Answer 11

ART
Treat opportunistic infections
Treat psychiatric comorbidities

Question 12

HIV drugs causing depression x2

Answer 12

Efavirenz
Raltegravir

Question 13

Autopsy findings in HAND that represent chronic inflammation x4

Answer 13

• Demyelination
• Microglial nodules
• Aggregates of microphages
• Grey matter loss with diffuse white matter changes

Question 14

Subcortical features are due to damage in which structures x2

Answer 14

Basal ganglia
Nigrostriatal tract

Question 15

Cortical features are due to damage in which structures x2

Answer 15

Frontal ad temporal lobes

Question 16

Describe 3 ways in which depression and HIV are linked

Answer 16

• Share same risk factors eg poverty
• HIV like other chronic disorders is associated with depression
• Depression > HIV because there is lack of motivation to use condoms

Question 17

Clinical features of depression in HIV and what they are mistaken for x3

Answer 17

Low mood- grief
Anhedonia- apathy
Sleep disturbance- chronic pain

Question 18

How does depression affect the 90-90-90 goals x4

Answer 18

• Decreased health seeking behaviors
• Decreased chances of PITC
• Delayed initiation of ART
• Poor adherence on ART

Question 19

Which antidepressant is most preferred in HIV and why x2

Answer 19

Amitriptyline
Reduces HIV neuropathy and insomnia

Question 20

Psychosocial management of IV and depression x5

Answer 20

CBT
Interpersonal therapy
Problem solving therapy
Adherence counseling
Harm reduction- condom use

Question 21

How does schizophrenia increase risk of HIV x3

Answer 21

Impulsivity
Sexual exploitation
Unable to negotiate for safe sex

Question 22

Why is carbamazepine not used as an antipsychotic in HIV x2

Answer 22

Reduces levels of ART
Risk of neutropenia

Question 23

Why is lithium not used in mood disorders for people with HIV x2

Answer 23

GIT side effects
Increases risk of delirium

Question 24

Why are people with HIV less likely to engage with health care providers x3h

Answer 24

Self stigma
Stigma from health care workers
Poor insight > poor health seeking behaviors