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HIV, psychosis and aging: past, present and future
Christian R Dolder1, Thomas L Patterson, Dilip V Jeste
1Department of Psychiatry, University of California San Diego, and Pharmacy Service, Veterans Affairs San Diego Healthcare System, USA.
Objective:
To review the clinical features, treatment issues, and research needs surrounding HIV infection in older adults with psychotic disorders and new-onset psychosis in HIV-infected individuals, while focusing on the implications of the highly active antiretroviral therapy (HAART) era and the use of atypical antipsychotic agents.
Design:
We searched the Medline/HealthStar database for articles that had examined new-onset psychosis in HIV disease and existing HIV infection in adults with psychotic disorders.
Results:
Individuals with psychotic disorders have an elevated risk of HIV infection. The risk factors for, prognosis for, and treatment of HIV disease may all be affected by older age. New-onset psychosis in HIV-infected individuals presents with a range of clinical features and is likely to remain a problem encountered in the near future, despite the treatment advances associated with HAART. Antipsychotic agents are the treatment of choice for psychosis in HIV-infected individuals. Research has demonstrated the sensitivity of HIV-infected individuals to the extrapyramidal side-effects of conventional antipsychotic agents, adverse effects that are reduced with the use of atypical antipsychotic agents.
Conclusion:
HIV, psychosis, and aging represent a trio with important clinical implications. HIV-infected older adults, a growing portion of the HIV population, face challenges in terms of concomitant illness, treatment sensitivity, and the potential for increased morbidity and premature mortality. Atypical antipsychotic agents in low doses represent an advance over conventional antipsychotic agents, although they do have their own side-effects.