Psychiatric Aspects of HIV/AIDS

In the era of rapid transmittal of health information and frequent educational updates via the Internet, hardcover medical texts still have a place. A worthy newcomer in this regard is Psychiatric Aspects of HIV/AIDS, edited by Fernandez and Ruiz, a comprehensive sourcebook with contributions by a panel of experts.

The contents are divided into 7 sections that cover background information, comorbidities, special populations, and other issues. The discussions start with the hard science of virology, immunology, transmission and disease stage, and extend to the psychosocial.

The book offers a good balance between the medical, neurological, and psychosocial aspects of HIV/AIDS. In other words, there is something here for everyone; those who practice HIV medicine and need to conduct a mental status examination or understand psychotropic drugs, or the mental health professional who needs an update on the medical aspects of HIV/AIDS.

One strength of this book is its thorough discussion of pharmacology of psychotropic drugs and their place in HIV medicine. The chapter by Bialer and colleagues, "Psychotropic Drug Interactions With Antiretrovirals," is worth reading for its discussion of the cytochrome P-450 pathways that metabolize antiretrovirals and psychotropic drugs.

The chapter by Breitbart on pain syndromes is equally strong; it discusses pain management, including adverse events, drug interactions, and nonpharmacological pain management interventions.

The section on special populations is concise and relevant, and reminds us once again of the significant racial and ethnic barriers to mental health treatment in the populations most affected by HIV/AIDS in the current era. Also worth reading is the chapter on HIV/AIDS in women who have sex with women (WSW), but not because sex between women is necessarily associated with increased risk of HIV infection. The authors acknowledge that sexual transmission risk of HIV in WSW is low and not well-documented. This chapter focuses on the behaviors and drug use, sexual assault, and the sex with men that occur with some frequency in this group.

What is the downside of this book? HIV/AIDS medicine is a constantly moving target, and any textbook on HIV/AIDS will always be just a snapshot in time. This book is no different. This book was published in 2006 and the list of antiretrovirals is incomplete. The discussion of the cytochrome P-450 enzyme system appears throughout various chapters discussing psychotropic and antiretroviral drugs. However, there is no discussion of the use of more recent pharmacogenomic tests that are designed to help with appropriate psychotropic drug selection. Also, the discussion of postexposure prophylaxis in the context of sexual assault is weak and refers only to guidelines from the CDC that are equivocal at best. More definitive guidelines from the New York State Department of Health (2005) that recommend postexposure prophylaxis for all survivors of sexual assault, regardless of what is known of the perpetrator, are not mentioned in the chapter by New York–based authors.

Those of us who treat HIV patients will look at the list of antiretrovirals and not be surprised that maraviroc is not on the list. That information is available elsewhere. On the other hand, what we do not know or have forgotten about psychiatric aspects of HIV is likely covered very well in the 400 or so pages of text, including the pharmacological aspects of psychotropic drugs and drugs of abuse. Overall, this was good reading, informative, and an afternoon well spent.

William M. Valenti, MD
University of Rochester School of Medicine and Dentistry
Rochester, NY