Book Review

Psychiatric Aspects of HIV/AIDS

N Engl J Med 2007; 356:532-533February 1, 2007

Article

Psychiatric Aspects of HIV/AIDS
Edited by Francisco Fernandez and Pedro Ruiz. 440 pp. Philadelphia, Lippincott Williams & Wilkins, 2006. $59.95. ISBN: 978-1-5825-5713-7

A quarter of a century from the beginning of the epidemic of the human immunodeficiency virus (HIV) and AIDS, in a world where 40 million people are estimated to be living with the virus and where, in 2005, 5 million new infections occurred, this book is a welcome addition to our understanding of the manifestations and challenges of HIV. The psychiatrists, psychologists, epidemiologists, neurologists, and other contributors provide a thoughtful, evidence-based, practical resource for those working in the field.

The book moves effortlessly from basic science and clinical research, through the epidemiology of HIV (incidence and risk factors for mental disease), to a compilation of practical tools to measure, monitor, and treat the psychiatric aspects of HIV and AIDS. The specifics of HIV science, the epidemiology of HIV infection in the United States, and the psychiatric disorders, predispositions, and diseases associated with various stages of HIV in different populations are clearly outlined.

The populations discussed, including women, children, homosexual men, the homeless, and prisoners, are specific to the United States, but the information the chapters contain is applicable in many parts of the world. Of practical use to psychiatrists and others in HIV care will be the section on coexisting conditions, including the stress–distress spectrum and adjustment disorders, anxiety disorders, mood disorders, psychotic disorders, sleep disorders, and the difficult areas of cognitive and substance-abuse disorders. Accurate and accessible information on psychotropic drug interactions with antiretroviral medications, and on detailed management of coexisting psychiatric conditions in medically ill patients, will provide a valuable reference in many settings. Diagnostic tools, including psychiatric assessment, psychological and neuropsychological testing, and the use of electrophysiology and brain mapping, are also covered. All readers will appreciate the excellent reviews of the literature on the epidemiology of coexisting psychiatric conditions, postulated pathophysiological processes, and the available data on evidence for diagnosis and treatment.

Since the beginning, the HIV epidemic has challenged scientists and clinicians to look beyond a narrow specialty; to broaden their horizons into new communities; to face multiple personal, community, and societal challenges; and to overcome personal biases and assumptions. This book offers essays on legal, health care provider, and policy issues, covering topics such as complementary holistic medicine, suicide, and end-of-life care. It also presents challenging and diverse views on biosocial, psychiatric, and psychological aspects of care and prevention and on individual and community responses.

Themes running through many chapters are the need for multidisciplinary approaches and for the early recognition of psychiatric and psychological factors in HIV medicine. Many authors stress the evidence that appropriate and timely consideration of psychiatric, psychological, and social needs is required to achieve adherence to combination antiretroviral therapy and to facilitate better outcomes for patients with HIV. Throughout the book, the integration of assessment and an early response to psychiatric and psychological disorders is identified as a key criterion for success in care models. Another innovative and consistent theme is the incorporation of psychological and psychiatric responses in the prevention of HIV infection. Many authors argue for combination prevention programs that include biological, educational, and behavioral interventions adapted for individuals, partnerships, and communities.

There are some disappointments in this book. As always, epidemiologic data that were accurate at the time of writing were rapidly overcome by the speed of this epidemic. Some areas of basic science are overlooked, such as the new understandings of the early loss of gut-associated lymphoid tissue in the pathogenesis of immune dysfunction. References to evidence-based interventions for prevention, including motivational interviewing, are followed by comments with details that go beyond the scope of the text. However, these and other small disappointments — including minor repetitions and inconsistencies and a U.S.-centric perspective — do not detract from the usefulness of this book. Would I purchase it? Definitely. Will I read it? Yes, frequently. Would I recommend it? Absolutely.

Anne M. Mijch, M.B., B.S.
Alfred Hospital, 3181 Melbourne, Australia
anne.mijch@med.monash.edu.au