The new profile of psychiatric disorders in patients with HIV infection

Nowadays, HIV infection is largely considered as a chronic condition rather than a deadly disease, given that effective antiretroviral treatment allows almost complete and persistent suppression of viral replication and restoration of nearly normal CD4+ T-cell counts. Being HIV a "condition", we imply that other illnesses are more frequently seen in persons living with HIV (PLHIV), among which mental health disorders are particularly common. Despite very successful antiretroviral therapy, HIV infection may still cause a wide range of neurocognitive dysfunctions and accelerated brain ageing. Beyond direct viral effects, at least another five causes of neurological damage are more frequent among PLHIV. First, the use of neurochemical substances as sexual boosters (chemsex) has become popular in this population. Second, the rate of sexually transmitted infections as syphilis, which may affect the central nervous system, is more prevalent among PLHIV. Third, the use of certain antiretroviral drugs, such as efavirenz, has been associated with changes in mood and/or psychotic symptoms. Fourth, an increased rate of mental disorders has been reported in PLHIV, either as predisposing conditions or following the recognition of HIV diagnosis (i.e., major depression). Finally, psychosocial factors such as loneliness, isolation and stigmatization are more frequent in PLHIV and worsen their mental health. Given that the life expectancy of PLHIV has increased significantly, a new and much broader spectrum of psychiatric disorders has emerged in PLHIV. Early diagnosis and adequate management, including education and preventative interventions are warranted.