Advances in Treatment of Psychiatric Disorders in Patients with HIV.

Psychiatric disorders have been shown to be risk factors for infection with HIV but have also been shown to be consequences of HIV infection, as well as barriers to effective care. Psychiatric disorders are associated with poor treatment outcomes, increased morbidity and mortality. Integrated care in clinics where mental health services are combined with psychiatric services has been shown to be effective in overcoming these issues. Major depression is a common psychiatric disorder in HIV patients at a 3-5 fold increased prevalence over background rates. Major depression increases the risk for infection but has also been shown to be a consequence of viral brain injury. Major depression is a barrier to successful treatment of HIV. Bipolar disorder has similar associations, but the data is weaker. Personality disorders are a risk factor for HIV infection, cause frustration for clinicians and are associated with poor treatment outcomes. This issue can be mitigated by integrated care of patients with this co-morbidity. Substance use and addiction are fundamental factors in HIV transmission. They are often encountered in clinics that treat HIV, but are often a barrier to care because of the lack of expertise in treating these conditions. Numerous psychological stressors are associated with HIV infection. Stigma, Post Traumatic Stress Disorder (PTSD) and disenfranchisement from medical care are surmountable barriers when psychiatric care is integrated with medical care. HIV populations are often underserved and impoverished and cutbacks in coverage for medical care will sabotage the efforts to eliminate HIV infection.