AIDS dementia-related psychosis: is there a window of vulnerability?

Human immunodeficiency virus (HIV) frequently enters the central nervous system (CNS) soon after infection, and frequently produces a wide variety of neurologic, cognitive, and psychiatric complications. Although, the entire spectrum of psychiatric illnesses may be seen in individuals with HIV infection, most are probably not directly caused by the virus. Psychiatric manifestations that are the direct result of HIV infection are usually seen in the setting of HIV-associated dementia. In this paper, it is proposed that these psychiatric manifestations of HIV infection can be phenomenologically separated into positive and negative symptoms. Negative symptoms are deficit states presenting as cognitive, social, or motivational deterioration; positive symptoms are psychotic or manic states that may occur in the course of the dementing illness. It is further purposed that there is a window of vulnerability to psychosis or mania that occurs relatively early in the dementing process. Consequently, advancing dementia would be expected to be associated with remission of psychosis.