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INTRODUCTION

Infection with the human immunodeficiency virus (HIV) is associated with a range of psychosocial and neuropsychiatric complications. While HIV/AIDS has become a manageable chronic disease for many patients, living with HIV/AIDS continues to be a practical and psychospiritual challenge. Persons at highest risk for HIV/AIDS (we use the term HIV/acquired immunodeficiency syndrome [AIDS] to designate the entire spectrum of clinical manifestations of HIV disease, from asymptomatic infection through advanced AIDS) are disproportionately likely to suffer behavioral and mood disorders and to be socially disenfranchised and economically disadvantaged. Once infected, they must contend with a still stigmatized, and if untreated, a progressive medical condition. In addition, many people with HIV have other significant comorbidities, such as chronic hepatitis, psychiatric problems, and/or substance use, which may make adhering to HIV treatment more difficult. Although patients with HIV/AIDS can present with life-threatening neuropsychiatric sequalae of HIV (central nervous system [CNS], opportunistic infections, HIV dementia), most patients’ behavioral concerns are focused on maintaining medication adherence, maximizing quality of life, and managing lifestyle issues.

EPIDEMIOLOGY & PREVENTION

Human immunodeficiency virus is primarily transmitted through sexual exposure or shared injection drug paraphernalia (sharing needles). Initially, the epidemic was concentrated among gay men in cities; now new cases of HIV infection are disproportionately seen in socioeconomically disadvantaged populations, especially women and men of color. Some patients do not fit “classic” risk factor profiles. For example, a monogamous woman may be infected through her husband who is bisexually active. Although past HIV prevention programs successfully reduced rates of new HIV infections in gay men, incidence of new HIV infection in multiple patient populations is significant. These patient groups include men who have sex with men but who do not self-identify as “gay,” speed users who share straws for intranasal use, teenagers, elders, and women. In the United States, about one-quarter of the over 1 million HIV-positive persons have never been tested and are not aware of their seropositive status. In spite of the great advances in treatment, HIV/AIDS remains underdiagnosed and undertreated in the United States and worldwide.

In 2006, the Centers for Disease Control (CDC) formally modified its HIV screening recommendations from that of focused testing in high-risk groups and in high-prevalence settings to universal screening. In this paradigm, all patients between the ages of 18–64 years are encouraged to be tested as part of routine preventative care, and detailed consent procedures have been modified to an opt in or out of HIV testing as part of routine care. Newer rapid testing procedures allow for patients to receive their results at the time of testing, improving the number of patients who receive their results and facilitating triage for medical follow-up. Evolving HIV treatment paradigms stress early and even universal treatment of HIV-infected patients. Theoretically, “test and treat” strategies will benefit patients by optimizing immune ...

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