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The advent of highly active antiretroviral therapy has prolonged the life expectancy of HIV patients and decreased the number of adults who progress to AIDS and HIV-associated dementia. However, neurocognitive deficits remain a pronounced consequence of HIV/AIDS. HIV-1 infection targets the central nervous system in subcortical brain areas and leads to high rates of delirium, depression, opportunistic central nervous system infections, and dementia. Long-term HIV replication in the brain occurs in astrocytes and microglia, allowing the virus to hide from antiviral medication and later compromise neuronal function. The associated cognitive disturbance is linked to both viral activity and inflammatory and other mediators from these immune cells that lead to the damage associated with HIV-associated neurocognitive disorders, a general term given for these disturbances. We review the severity and prevalence of the neuropsychiatric complications of HIV including delirium, neurobehavioral impairments (depression), minor cognitive-motor dysfunction, and HIV-associated dementia.

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HIV risk behaviors before incarceration were highly prevalent among the women in this study. Rates of PTSD, depression, and dysthymic disorder were also high. PTSD was associated with prostitution and receptive anal sex, and the disorder may contribute to high rates of risky sexual behavior. Targeted HIV risk reduction efforts among women prisoners should include evaluation for PTSD; conversely, women prisoners with a diagnosis of PTSD should be evaluated for prior HIV sexual risk behaviors.

Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population.It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

Patients with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome have high rates of psychiatric illness. The effective management of these psychiatric conditions can improve a patient's quality of life and may improve antiretroviral adherence. Care providers for patients with HIV infection frequently encounter clinical situations in which psychotropic medications are needed or are being used. Those clinical situations require familiarity with the broad category of medications termed "psychotropic." That familiarity should include a basic understanding of indications, adverse effects, and drug interactions. In particular, it is very important to recognize the many potential interactions based on cytochrome P450 metabolism, which is common to many psychotropics, the protease inhibitors, and the nonnucleoside reverse-transcriptase inhibitors. In a brief review of the use of psychotropic medications in patients with HIV infection, we discuss indications, adverse effects, and drug interactions for commonly used antidepressants, mood stabilizers, anxiolytics, antipsychotics, psychostimulants, and drugs of abuse.Patients with AIDS are at higher risk for mental illness than the general population. Prevalences for major depression among patients with HIV infection only and patients with AIDS have been estimated to be between 15% and 40%, far above the prevalence for the general population [1]. Additionally, mental illness places patients at risk for contracting HIV infection. In a study of 671 patients at the Baltimore City Health Department Sexually Transmitted Disease clinic, a diagnosis of depression was associated with behaviors placing one at risk for HIV infection [2]. That 3%-23% of adults with severe mental illness are HIV infected, compared with 0.6% of the population in the United States, is likely related to such highrisk behavior [3]. Mental illness also impacts a patient's ability to adhere to complicated antiretroviral regimens [4]. Treatment of comorbid mental illness in HIV-infected patients, however, can improve adherence to HAART regimens [5].Psychiatric disorders are under-recognized and under-treated in patients with chronic medical illness. In 1996, an epidemiologic study examined a representative sample of 2864 patients receiving medical care for HIV infection [6]. In addition to finding a 12-month prevalence of nearly 50% for psychiatric illness, 27.2% of all HIV-infected patients receiving medical care were taking a psychotropic drug. Antidepressants were the most common (20.9% of all patients), followed by anxiolytics (16.7%), antipsychotics (4.7%), and psychostimulants (3%). Over one-half of the patients reporting a major depressive disorder were not treated with antidepressants [7].We will discuss the indications and uses of psychotropic medications (antidepressants, anxiolytics, mood stabilizers, antipsychotics, psychostimulants, and drugs of abuse) in the HIV clinic. Our goal is to promote the rational treatment of psychiatric disorders in HIV-infected patien...

Major depression and demoralization are very common in patients with cancer. A discussion of the diagnostic specificity of major depression and demoralization (also known as adjustment disorder) is presented here, followed by a review of some effects of comorbid depression and cancer. Finally, there are a brief review of studies of antidepressant pharmacotherapy in cancer patients, a treatment algorithm for antidepressant therapy, and suggestions for treatment of demoralization.