Overview: The Management of the HIV-Positive Patient with Neuropsychiatric Impairment

  • David G. Ostrow
  • J. Hampton AtkinsonIII
  • Igor Grant


The assessment and management of neuropsychiatric (NP*) disturbances in the patient with acquired immunodeficiency syndrome (AIDS) must begin with an understanding of the criteria by which AIDS and other manifestations of human immunodeficiency virus (HIV) infection are diagnosed. Table 1 shows the criteria used by the Centers for Disease Control (CDC) for the classic definition of AIDS, which in large part, is a diagnosis of exclusion.1 The core features include a defect in cell mediated immunity with presence of an opportunistic disease, the most common being Pneumocystis carinii pneumonia (PCP) and/or neoplasia in the form of Kaposi’s sarcoma (KS). With discovery of the agent responsible for the immune deficiency of AIDS, HIV,2–4 the original concept of an AIDS patient being without a known cause of immune deficiency becomes irrelevant. This means that the occurrence of certain disease processes in the presence of a positive HIV antibody test are taken as diagnostic of AIDS.5 Included in this list of conditions qualifying as AIDS are two recently added conditions: severe weight loss (the “wasting syndrome”) and severe neurological illness (the so-called “AIDS dementia complex” or ADC). It must be kept in mind that none of these diseases is a direct measure of the underlying HIV infectious disease process.


Human Immunodeficiency Virus Human Immunodeficiency Virus Infection Acquire Immune Deficiency Syndrome Acquire Immunodeficiency Syndrome Pneumocystis Carinii Pneumonia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • David G. Ostrow
    • 1
  • J. Hampton AtkinsonIII
    • 2
    • 3
  • Igor Grant
    • 2
    • 3
  1. 1.Midwest AIDS Biobehavioral Research Center, Institute for Social Research, and Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborUSA
  2. 2.Psychiatry ServiceSan Diego Veterans Administration Medical CenterSan DiegoUSA
  3. 3.Department of PsychiatryUniversity of California, San Diego School of MedicineLa JollaUSA

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