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Psychopharmacology in HIV-Infected Patients

From the Department of Psychiatry (M.J.R.), Provena Covenant Medical Center, Champaign, Illinois, and the Psychology Department, University of Illinois at Urbana-Champaign, Champaign, Illinois; and McKnight Brain Institute (J.M.P.), Departments of Psychiatry, Neuroscience, and Pharmacology, University of Florida College of Medicine, McKnight Brian Institute, Gainesville, Florida.

Address correspondence and reprint requests to Martin J. Repetto, Department of Psychiatry, Provena Covenant Medical Center; Psychology Department, University of Illinois at Urbana-Champaign, 407 E. University Avenue, Champaign, IL 61820. E-mail: RepettoM.D.Martin{at}provena.org.

Neuropsychiatric disorders and syndromes may be underdiagnosed and inadequately treated in individuals infected with HIV. Depression in particular is among the most prevalent diagnoses, and data from controlled clinical studies have shown that antidepressant medications are efficacious and safe for treating depression in HIV-infected persons. A significant shortcoming of this literature is that most of the available data are from studies conducted before the advent of highly active antiretroviral therapy. In addition, apart from antidepressant medications, controlled studies systematically assessing efficacy and safety issues for other classes of psychotropic drugs (e.g., antipsychotic and anxiolytic medications) in HIV-infected persons are lacking. This review summarizes essential findings pertaining to the use of psychotropic medications to treat depression and other neuropsychiatric disorders in the context of HIV. It includes a discussion of clinically relevant treatment considerations (e.g., side effects, drug-drug interactions) derived from the existing literature as well as judgments that clinicians face in the absence of research data. Despite some shortcomings of the existing literature, overall there is compelling evidence that the appropriate use of psychotropic medications (coupled with behavioral therapy) can improve the quality of life of mentally ill HIV-infected individuals.

Key Words: neuropsychiatric disorders • depression • highly active antiretroviral therapy • psychotropic medications

Abbreviations: HAART = highly active antiretroviral therapy; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; SNRI = serotonin and norepinephrine reuptake inhibitor.

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