HIV and Mental Health-Mod 2 Flashcards
What does ‘HIV’ stand for?
Human immunodeficiency viruses
What is HIV?
HIV, or human immunodeficiency virus, is the virus that causes AIDS (acquired immunodeficiency syndrome) and can be transmitted during sexual intercourse; by sharing syringes; or perinatally during pregnancy, childbirth or breastfeeding
What does HIV do?
HIV attacks the immune system by destroying CD4+ T cells, a type of white blood cell that is vital to fighting off infection. The destruction of these cells can leave people with untreated HIV vulnerable to life-threatening infections and complications.
What are some behavioural changes seen in HIV patients?
apathy, social withdrawal, but sometimes agitation, anxiety, irritability, emotional lability
What signs/symptoms can be seen in HIV patients?
-variable presentations
-multiple foci of inflammatory change in cortex, white matter.
-occurs with profound immunosuppression (very low CD4)
-present with confusional state
-nonspecific- memory, concentration, drive, mood etc.
-Mental slowing
-psychosis-like features
What is progressive multifocal leucoencephalopathy?
-a neurological condition caused by the JC virus.
-severe, progressive, fatal demyelinating disease that presents in immunocompromised states
-PML is a disease of the CNS resulting in destruction of the myelin sheath that covers nerves. Diffuse white matter damage, shown up on scans as low density lesions with ‘scalloped’ edge.
-Progressive dementia with pareses, ataxia, dysphasia etc.
What are some examples of HIV medications?
Nucleoside reverse transcriptase inhibitors e.g. abacavir, didanosine, lamuvidine, tenofovir.
What are side effects of ‘Nucleoside reverse transcriptase inhibitors’ e.g. abacavir, didanosine, lamuvidine, tenofovir?
-abnormal dreams
-depression
What are some examples of non-nucleoside reverse transcriptase inhibitors?
-efavirenz
-nevirapine
What are some side effects of non-nucleoside reverse transcriptase inhibitors?
-abnormal dreams
-sleep disturbance
-fatigue
-depression
-psychosis
-suicidal ideas
What are some examples of protease inhibitors?
atazanavir, lopinavir, ritonavir, saquinavir
What are some side effects of protease inhibitors?
sleep disturbances, drowsiness, fatigue and anxiety
What are some side effects of Hepatitis C treatment?
Interferon for treatment of Hepatitis C is often very unpleasant, and said to exacerbate or provoke “depression”.
What are some interactions with psychotropics for HIV meds?
Benzodiazepines are metabolised through cytochrome P450 and can therefore cause excessive sedation.
But SSRIs may cause additive nausea and diarrhoea which may affect adherence.
Chlorpromazine has high incidence of adverse effects.
What are psychotropics which could be considered?
-Atypical anti-psychotics (eg olanzapine, risperidone) with treatment starting with lower doses than normal. Unacceptable extra-pyramidal side-effects are a risk. -
Lipodystrophy and impaired glucose metabolism due to some HIV medication may be exacerbated by some atypical antipsychotics.
-anticonvulsants, avoid carbamazepine, phenytoin, primidone where possible. Lamotrigine has no potential interactions.
-Mood stabilisers: choose Valproate
