Book Review

Psychological Medicine of HIV Infection

N Engl J Med 1996; 335:1470-1471November 7, 1996

Article

Psychological Medicine of HIV Infection
By José Catalán, Adrian Burgess, and Ivana Klimeš, with the collaboration of Brian Gazzard. 300 pp. New York, Oxford University Press, 1996. $75. ISBN: 0-19-262202-1

The theme of this year's 11th International AIDS Conference, “One World, One Hope,” was amply borne out, for better and for worse, by the presentations. For the first time in years, there was a real feeling of optimism about the potential for treatment, based on early results of new multidrug protocols. At the same time, the epidemiologic data reinforced an awareness of human immunodeficiency virus (HIV) infection as a global problem that is not going away any time soon. An estimated 8500 new infections occur daily. In some developing countries 30 percent of women giving birth are infected with HIV. The incidence of new infections among some populations of young gay men is increasing. Vaccines, which offer the only realistic chance for prevention in much of the world, remain a long way off. Thus, despite the hope, HIV infection and AIDS are going to be with us for the foreseeable future.

Against that background, this book comes as a welcome and valuable resource for any clinician caring for patients affected by or infected with HIV. The interaction between HIV infection and mental health bears some resemblance to the long-standing issue of which came first, the chicken or the egg. HIV infection can contribute to the development of a variety of psychiatric syndromes and behaviors, including depression, anxiety, suicidal behavior, and cognitive disorders. At the same time, a number of studies have suggested that within the traditional risk categories for HIV infection both axis I and axis II psychiatric disorders appear to increase the risk of HIV infection, perhaps by affecting impulse control and judgment. An extensive literature has attempted to define and describe this complex relation between HIV infection and mental health and mental illness. In this book, Dr. Catalán and his colleagues have undertaken a comprehensive review of this complicated subject. A sometimes dizzying array of articles and statistics is presented on all aspects of the interrelation between HIV and mental health. The list of topics is extensive, including issues surrounding testing, the treatment of patients in the various stages of infection, the diagnosis and treatment of psychiatric disorders, cognitive disorders, ethical and legal issues, the HIV-infected health care provider, and physician-assisted suicide. It is hard to think of a topic of interest or debate in this field that is not touched on. However, the very comprehensiveness of this relatively brief book (224 pages of text and 64 pages of references) sometimes leads to superficiality. Although all the bases are covered, it is not possible to present so many topics in the depth that at least some deserve.

The very comprehensiveness of the literature review also presents the reader with several challenges. Each chapter has a brief summary at the end, and some also include summaries after each section, but the authors' evenhanded presentation of opposing viewpoints often leaves the reader in the position of determining where reality lies. They also do not always differentiate between older and newer material. In the world of AIDS, articles from the end of the 1980s often describe an entirely different landscape from the one we inhabit today, but on a number of occasions, such material, although perhaps important in its time, is presented uncritically. The authors are based in London and Oxford and thus tend to draw on a wider range of sources, including more of the European literature, than many American textbooks. This advantage is, on a few occasions, offset by a seemingly lesser familiarity with American issues.

The title and format suggest an effort to make this book of use to a wide range of clinicians, instead of aiming more narrowly at mental health providers, and this again leads to some superficiality. Thus, the chapter on mental-status examination is too elementary for the mental health professional, and the review of medical conditions and treatment is too elementary for the infectious-disease expert. However, despite these flaws, this book is broad enough in its approach to offer something of value to almost anyone involved in AIDS care. It is a compendium of research and data that deserves a place on the bookshelf, and one that I anticipate will find its way down from the bookshelf quite often in my office.

Mary Alice O'Dowd, M.D.
Montefiore Medical Center, Bronx, NY 10467