Approximately 1 million persons are now infected with human immunodeficiency
virus (HIV) in the United States. Evidence exists that psychiatric disorders
are common in patients with HIV and that these patients may not receive optimal
care because their psychiatric disorders are a barrier to medical care, communication
with clinicians, and adherence to medical recommendations. We describe herein
a complex case seen at The Johns Hopkins Hospital with several psychiatric
conditions that are common in our HIV clinic population. We describe the collaborative
treatment of the patient by a multidisciplinary team including both medical
and mental health practitioners. We briefly describe a coherent diagnostic
and treatment approach to patients in HIV clinics and the supporting rationale
from the literature. We discuss the need for comprehensive evaluation, a multidisciplinary
treatment team, and therapeutic optimism.
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