The neuropsychiatric aspects of HIV infection

Neuropsychiatric manifestations of HIV infection require aggressive and thorough diagnosis and treatment. Because people may live longer on antiviral therapy and chemoprophylaxis for opportunistic infections, a great emergence of neoplastic challenges to the central nervous system and the possibility of primary HIV encephalopathy appear. Because the mind is the container of all that makes us human, attention to these insults is essential to maintain quality of life, autonomy, and psychologic health as long as possible. Primary care providers can play a major role in this process. New chemotherapeutic interventions will continue to provide hope while longing for a cure or lifelong treatment, containing the tension between realistic optimism and appropriate resignation concerning any one particular individual's condition. Helping patients to see their brain as an organ system that deserves equal attention as the rest of the body is part of the primary provider's role. Finally, when further technologic and pharmacologic interventions are unavailable, the primary care provider serves the most important function by staying by the patient and her or his significant others until the very end of life.