Table 5 Distribution of responses of participant undertaking ART. Table 6 Clinical presentation age wise. Table 8 Clinical presentation income wise. Table 7 Clinical presentation sex wise. Tindell B, Cooper DA. Psychiatric morbidity in HIV infected individuals.
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J Child Adolesc Psychopharmacol. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Changes in the virus, with respect to both predominant cell tropism and virulence may be important. A number of studies have shown early invasion of the CNS and early local host immune responses in the cerebrospinal fluid CSF. A critical question remaining to be answered is whether the virus then persists in the CNS in latent form or as an indolent infection that is asymptomatic. If it can remain latent, it is important to know what cells might harbor the proviral DNA: microglia, astrocytes, or other CNS cells.
Pathological observations to date suggest that the virus indirectly injures the brain rather than directly killing or infecting nerve cells. This distinguishes HIV from other viral infections of the brain, such as those caused by poliovirus or herpes simplex virus. Understanding the pathogenic mechanisms has great potential importance for treating ADC patients not only using methods that interfere with the virus, but also strategies directed at interrupting some of its toxic processes.
Indeed, these considerations underlie some of the approaches now being taken to treat ADC, including treatment protocols using nimodipine, a calcium channel blocker that can prevent gp induced neuronal death in vitro , and pentoxyphilline, an antagonist of Tumor Necrosis Factor. Research on ADC and CNS HIV infection has biological importance not only for understanding the nature and course of HIV infection, but also more generally for suggesting mechanisms involved in other infectious, immunological, and neurodegenerative diseases.
The early penetration of the blood-brain barrier by HIV, the local immune response detected in the spinal fluid, and the subsequent active replication of HIV in the brain late in infection hold clues regarding the CNS ecology of HIV. The second type of interaction among brain, behavior, and HIV relates to the unique issues associated with multiple diagnoses, that is diagnosis of any combination of HIV, drug or alcohol abuse, and mental illness.
Drinking alcohol to excess has been shown to cause damage to the immune system Kruger and Jerrells, It therefore seems reasonable to assume that alcohol consumption in significant amounts. Alcohol may increase the susceptibility of phagocytes to initial infection, impairing their ability to eliminate the virus in the early stages of infection, and thus increasing their potential to function as reservoirs for HIV Kruger and Jerrells, Alcohol also reduces the number of T-cells in the spleen, lymph nodes, thymus, and blood Jerrells, Smith, and Eckardt, ; Saad and Jerrells, This loss of cells in the immune system may accelerate the onset of clinical manifestations among HIV-infected people, but research on this issue is inconclusive.
Although it is clear that excessive alcohol consumption can impair cell-mediated immunity, this has not translated into accelerated clinical progression of HIV to AIDS in reports to date Isaki and Gordis, ; Kaslow et al. Treatment of drug users who are at risk for or already infected with HIV is complicated by many factors: the fact that the clinical course of HIV infection may have special characteristics among drug injectors, the existence of complex medical and psychosocial comorbidities, and the often tenuous relationship between drug users and the health care system.
Although a significant body of research has been conducted on clinical aspects of HIV disease and its management among drug users, a number of key research areas require further examination. These include: charting changes in the spectrum of HIV disease over time, such as, the emergence or disappearance of AIDS-related illnesses in this group as a result of medical interventions or other differences; further epidemiologic and clinical study of tuberculosis among HIV-infected drug users; and clarifying further the clinical expression and outcome of hepatitis C infection in co-infected groups Donahue et al.
Pharmacokinetic and other pharmacologic studies involving drugs of abuse and medications used for the treatment of HIV-related disease, as well as prescribed opioids such as methadone used to treat opiate addiction, will help determine whether interactions have potential clinical significance. With the increasing number of medications continually being added to the standard therapeutic regimens of HIV-infected patients, it will be even more important in the future to assess these agents pharmacologically in relation to psychoactive drugs, both prescribed and over-the-counter drugs.
Because most of the therapies used for HIV infection and related conditions e. Finally, because drug injectors as a group are likely to have a high lifetime prevalence of depression, anxiety, personality disorder, and other psychiatric diagnoses Batki, a; Rounsaville et al. On this point, a research and clinical agenda that brings together mental health services, drug abuse treatment, and medical care for HIV should be pursued. This will frequently require crossing categorical boundaries that separate research and services programs. The convergence of psychiatric disorders, substance abuse, and HIV among those already infected who are also severely mentally ill raises difficult questions about appropriate treatment, similar to those related to injection drug users.
For example, possible toxic reactions between antipsychotic and anti-HIV medications, and perhaps even antinarcotic medications, require further investigation. Moreover, little if anything is yet known about HIV disease progression among the seriously mentally ill. Given what has already been learned about the interactions of the virus and the CNS, it is possible that there are unique manifestations among people already suffering brain disorders.
Yet, this area remains remarkably understudied. The final type of brain, behavior, and HIV interaction addressed in Chapter 4 is the relationship between HIV infection and certain psychiatric disorders, behavioral states, or reactions. For example, concern about HIV infection can lead to anxiety or depression. The stress of coping with the illness is not confined to the person infected, but also encompasses those who care for him or her.
While not directly related to HIV infection per se , there are both diagnostic and therapeutic implications in the management of HIV infection. The bidirectional relationship between psychosocial factors and HIV infection may influence disease progression and the ability to effectively treat related symptoms. These phenomena primarily have been informed by two types of research: psychoneuroimmunology and psychosocial research on coping and caregiving.
Stress and other nervous system perturbations may alter immune function in both animal models and humans. Although much has been learned about the effects of HIV on psychosocial factors, less is known about the effects of psychosocial factors on HIV.beauseugoslu.tk
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For example, among gay men, psychiatric morbidity rates are relatively high regardless of HIV serostatus. This may be due to the fact that these men have to deal with a host of psychological issues related to being gay and their consequent status in society Atkinson et al. This finding suggests the need to understand how the context of HIV affects psychiatric symptoms among gay men, that is, what disclosure and recognition of both being gay and having HIV may mean. After learning that they are HIV positive, most people employ strategies of coping and social support that vary at different stages of the disease.
Studies of asymptomatic HIV-positive people suggest that ''avoidant coping"—screening out the negative implications and focusing instead on the positive—does not protect them from emotional distress Joseph et al. Cognitive coping strategies, however, such as positive reinterpretation, sense of control over events, and positive changes in daily life, seem to promote psychological well-being throughout the course of the disease Hart et al. To date, nearly all of the research on coping—including that on bereavement after the death of someone with AIDS—has focused on gay men.
Most informal AIDS caregivers. Although stress experienced by formal HIV caregivers is reported in professional and lay articles, research has not included systematic documentation of the incidence and prevalence of physical, psychological, occupational, or interpersonal symptoms or disorders in health care professionals who devote a substantial amount of their clinical activities to patients with HIV illness Silverman, Anecdotal reports of various symptoms, such as AIDS-related nightmares and psychological numbing, together with other symptoms related to stress and depression, suggest that some caregivers might be experiencing a form of posttraumatic stress disorder.
However, according to Silverman , only one published psychiatry article has addressed this possibility Horstman and McKusick, After reviewing the literature on disease progression and intervention in Chapter 4 , the committee makes a number of recommendations:. This research might include studies. Special attention should be given to patterns and consequences of caregiving in such families.
Chapter 5 discusses these contextual factors. Overall, the reorganization appears to have had only a limited effect on the research programs of the three institutes to date.