To the Editor: In their Special Communication on the treatment of adult human immunodeficiency virus (HIV) infection, Dr Hammer and colleagues1 did not mention the significant psychosocial aspects of this disease. Evaluation and management of psychiatric, neuropsychiatric, and substance abuse problems is essential in the successful treatment of HIV/AIDS. Recognizing the mental health-related manifestations of HIV is often complicated by the complex interaction of psychosocial and biological factors. A wide spectrum of psychiatric disorders has been associated with HIV: mood, anxiety, cognitive, psychotic, personality, sleep, sexual, and substance use disorders.2 Estimates of lifetime and past-year prevalence of psychiatric disorders in individuals with HIV/AIDS are as high as 68% to 89%.3 The percentage of HIV-positive patients with any cognitive impairment during the course of their illness is 38.8% to 54.4% overall, and for those meeting full criteria for dementia is 10.4% to 25.2%.4
It is arguable whether the high prevalence of psychiatric disorders among HIV-positive persons is due to high rates of preexisting illness or increased risk for HIV infection among those with mental illness. Some propose that anxiety, depression, and suicidal ideation may be a response to patients learning their seropositive status or the subsequent symptoms and disability associated with HIV.5 There is increased risk of suicidal ideation and suicide attempts in people with HIV/AIDS, particularly among women, who are up to 5 times more likely to have ever attempted suicide than HIV-negative women.6
Adherence to antiretroviral therapy is adversely affected by psychiatric and neuropsychiatric disorders and substance abuse.3 These disorders and psychosocial stressors are strongly correlated with nonadherence to antiretroviral therapy and complex medical regimens, viral resistance, treatment failure, and ultimately poor outcomes. The comprehensive treatment of persons with HIV/AIDS is incomplete without a social history, psychiatric review of systems, mental status examination, and evaluation of the patient's cognitive status. Referral to mental health specialists, substance abuse treatment, and social workers is often necessary for successful HIV treatment.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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