HIV

Question 1

What demographics are at highest risk for HIV?

Answer 1

White British homosexuals and African female heterosexuals

Question 2

What are the initial signs of HIV infection?

Answer 2

Asymptomatic or minor cold symptoms

Question 3

What conditions are associated with direct invasion of the brain by HIV?

Answer 3

▪️HIV encephalopathy
▪️AIDS dementia complex

Question 4

When do neuropsychiatric symptoms usually occur in HIV?

Answer 4

In later stages when profound immunosuppression have occurred

(very low CD4)

Question 5

What other causes of neuropsychiatric symptoms could be considered in someone with HIV?

Answer 5

Coincident active opportunistic infections (e.g. toxoplasmosis)

Question 6

What is CD4?

Answer 6

A type of white blood cell used as a marker of immune function

Question 7

What is normal CD4?

Answer 7

> 1,000

Question 8

How does CD4 change across HIV infection?

Answer 8

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.

Question 9

What happens as your CD4 gets lower?

Answer 9

You become immunocompromised and are more susceptible to other infections and the entry of these into the brain.

Question 10

If CD4 becomes very low (~100), how much can CD4 be improved with treatment?

Answer 10

Normally only to around 500

(immune system is still 50% down)

Question 11

What are some of the early neuropsychiatric symptoms of HIV infection?

Answer 11

▪️Memory difficulties
▪️Concentration difficulties
▪️Apathy
▪️Mood disturbance
▪️General mental slowing preceding specific deficits

Question 12

What behavioural changes may be apparent with HIV infection?

Answer 12

▪️Apathy
▪️Social withdrawal
▪️Agitation
▪️Anxiety
▪️Irritability
▪️Emotional lability

Question 13

What acute signs may indicate active HIV infection in the brain?

Answer 13

▪️Organic psychosis-like features (hallucinations, delusions)
▪️Motor dysfunction (poor balance, weakness, worse handwriting)

Question 14

Without treatment, how quickly do neuropsychiatric symptoms deteriorate into a severe state?

Answer 14

Usually within months but may be longer

Question 15

What condition may occur at extremely low levels of immunity in HIV?

Answer 15

Progressive multifocal leukoencephalopathy

Question 16

What is progressive multifocal leukoencephalopathy?

Answer 16

A disease of the CNS resulting in destruction of the myelin sheath and diffuse white matter damage

Question 17

How might PML present on a CT scan?

Answer 17

Low density lesions with ‘scalloped’ edges

Question 18

What are the symptoms of PML?

Answer 18

▪️Rapidly progressive dementia
▪️Motor difficulties such as paresis, ataxia, and dysphagia

Question 19

What is the prognosis of PML?

Answer 19

Usually very poor but improving. Some people can make a full recovery

Question 20

Is there a relationship between cognitive performance and immunity in asymptomatic HIV positive subjects?

Answer 20

No

Question 21

What type of dementia is HIV dementia most similar to?

Answer 21

Parkinson’s dementia

Question 22

Is there a relationship between HIV and other psychiatric diagnoses?

Answer 22

No, although depressive symptoms in those with HIV may show improvement associated with improvement in physical HIV symptoms

Question 23

Which other populations have shown increased rates of HIV infection compared to the general population?

Answer 23

▪️Psychiatric inpatients
▪️Homeless people
▪️Individuals with schizophrenia

Question 24

What neuropsychiatric side effect has been associated with interferon for treatment of Hepatitis C?

Answer 24

Depression

Question 25

What are the main types of HIV medication?

Answer 25

▪️Nucleoside reverse transciptase inhibitors ▪️Non-nucleoside reverse transciptase inhibitors ▪️Protease inhibitors

Question 26

What side effects have been associated with nucleoside reverse transciptase inhibitors?

Answer 26

Abnormal dreams and depression

Question 27

What side effects have been associated with non-nucleoside reverse transciptase inhibitors?

Answer 27

Abnormal dreams, sleep disturbance, fatigue, depression, psychosis, suicidal ideation

Question 28

What side effects have been associated with protease inhibitors?

Answer 28

Sleep disturbance, drowsiness, fatigue, anxiety

Question 29

What is the main difference between the three types of HIV medication?

Answer 29

They target different points in the progression of HIV

Question 30

What class of drugs show interactions with HIV medication?

Answer 30

Psychotropics, particularly benzodiazepines and some antipsychotics

Question 31

What side effect may be seen with the interaction of HIV medication and benzodiazepines?

Answer 31

Excessive sedation

Question 32

What type of antidepressant is most likely to interact with HIV medication?

Answer 32

Tricyclic

Question 33

Which antipsychotic has a high incidence of adverse effects in HIV?

Answer 33

Chlorpromazine

Question 34

How do psychotropics typically interact with HIV medication?

Answer 34

via cytochrome P450 enzymes

Question 35

What type of antipsychotic is preferred for someone with HIV?

Answer 35

Atypical antipsychotics (e.g. Olanzapine, risperidone) at lower than normal doses

Question 36

What HIV medication side effects may be exacerbated by antipsychotics?

Answer 36

▪️Lipodystrophy ▪️Impaired glucose metabolism

Question 37

Is poorly controlled HIV associated with greater fatigue?

Answer 37

No! Fatigue levels are more associated with psychological factors