Neuropsychiatric morbidity in early HIV disease: implications for military occupational function

The Military Medical Consortium for Applied Retroviral Research Program's (MMCARR) Behavioral Medicine Human Immunodeficiency Virus (HIV) Research component is conducting a tri-service, comprehensive, and longitudinal research study in military HIV-infected personnel at all stages of infection. Identification of neuropsychiatric and psychosocial outcomes and their determinants will help the military minimize the impact of the HIV epidemic on military readiness and function. Neuropsychiatric and psychosocial findings are among the most common complications seen in early HIV disease and among the most likely to have an adverse impact on military readiness and function. The study has demonstrated that the average HIV-infected service person experiences at least transient military occupational difficulty following notification of HIV status. More than 15% at any given time have levels of clinical or subclinical anxiety or depression that are referrable for mental health intervention. Ten per cent of study subjects have a current major mood disorder and 5% have a psychoactive substance use disorder. Finally, 17% of study subjects have experienced serious suicidal ideation or behaviours at least once since notification of seropositivity. Fortunately, however, data also indicate at least partial effectiveness of current primary, secondary and tertiary preventive efforts. Only about 1% of Air Force HIV-infected persons are discharged for psychiatric reasons prior to eventual medical discharge. Further, a large majority of active-duty patients demonstrate solid military occupational and social performance. Though military HIV neurobehavioural research is still in progress, preliminary data identify social support and pre-HIV psychiatric predisposition as important factors associated with current neuropsychiatric status.