Mental health and HIV/AIDS are closely interlinked.  Mental disorders, including substance-use disorders, are associated with increased risk of HIV infection and affect adherence to and efficacy of antiretroviral treatments.  Conversely, HIV infection can increase risk for neuropsychiatric complications including stress, mood, and neurocognitive disorders.

This book provides clinicians with a comprehensive evidenced-based and practical approach to the management of patients with HIV infection and co-morbid mental disorders. It provides up-to-date and clear overviews of current clinical issues, as well as the relevant basic science.  Information and data from studies of different HIV groups (eg men who have sex with men) make the text relevant to a broad spectrum of clinicians, including those working with low socioeconomic status groups in high income countries and those working in the developing world.

The book uses the popular format of the World Psychiatric Associations Evidence and Experience series.  Review chapters summarize the evidence on the epidemiology, pathogenesis and clinical aspects of mental disorders in HIV,and interventions (both psychotherapy and psychopharmacology including drug-drug interactions).  These are complemented by commentaries addressing particular facets of each topic and providing insight gained from clinical experience.

Psychiatrists, psychologists and all mental health staff working with HIV-infected patients will find this book of great benefit.

John A. Joska is a Head of the Division of Neuropsychiatry in the Department of Psychiatry and Mental Health at the University of Cape Town. He is the Director of the UCT HIV Mental Health Research Unit, and the Western Cape Provincial Programme Manager for HIV Psychiatry. His interests are in HIV and Mental Health, particularly mechanisms of HIV-associated neurocognitive disorders, mental health services, and general neuropsychiatry. John completed both under- and post-graduate training at UCT. Following completion of his fellowship in psychiatry in 2002, he obtained the Mmed (psychiatry) in 2006, and his PhD in the Neurocognitive Disorders of HIV in 2011. John has been involved in several innovative research projects, including the development of assertive community outreach programmes in the Province, and the development of a smartphone application to assist primary health care providers to assess for the presence of dementia. His group was recently funded to conduct a randomized controlled trial of lithium in HIV-associated dementia. He is excited by the opportunities and challenges provided by working in Cape Town, South Africa.

Dan J Stein is Professor and Chair of the Dept of Psychiatry and Mental Health at the University of Cape Town, Director of the Medical Research Council (MRC) Unit on Anxiety Disorders, and Visiting Professor of Psychiatry at Mt.  Sinai Medical School in New York.  He is interested in the psychobiology and management of the anxiety, obsessive-compulsive and related, and traumatic and stress disorders.  He has also mentored work in other areas that are of particular relevance to South Africa and Africa, including neuroHIV/AIDS and substance use disorders.
Dan did his undergraduate and medical degrees at the University of Cape Town, and his doctorate (in the area of clinical neuroscience) at the University of Stellenbosch.  He trained in psychiatry, and completed a post-doctoral fellowship (in the area of psychopharmacology) at Columbia University in New York.  His training also includes a doctorate in philosophy.  He is inspired by the way in which psychiatry integrates science and humanism, and contributes to addressing some of the big questions posed by life.

Dan's work ranges from basic neuroscience, through clinical investigations and trials, and on to epidemiological and cross-cultural studies.  He is enthusiastic about the possibility of clinical practice and scientific research that integrates theoretical concepts and empirical data across these different levels.  Having worked for many years in South Africa, he is also enthusiastic about establishing integrative approaches to services, training, and research in the context of a low and-middle-income country.

List of Contributors ix

Preface xv

1 Epidemiology of Psychopathology in HIV 1
Milton L. Wainberg, Karen McKinnon, and Francine Cournos

Commentaries

1.1 Epidemiology of Psychopathology in HIV: Neurocognitive Disorders 34
Bryan Smith and Ned Sacktor

1.2 Depression and Anxiety Disorders in HIV/AIDS 40
Seggane Musisi

1.3 Substance Use Disorders and HIV: Evolving Syndemics 46
Sheri L. Towe and Christina S. Meade

1.4 Severe Mental Illness and HIV 55
Etheldreda Nakimuli-Mpungu

2 Pathogenesis of Mental Health Disorders in HIV 61
Gursharan Chana, Chad A. Bousman, and Ian P. Everall

Commentaries

2.1 Behavioural and Social Risk Factors for HIV 82
Landon Myer

2.2 Brain Imaging and Neuro-HIV 87
Christine Fennema-Notestine

2.3 Host Genetics in HIV-Associated Neurocognitive Disorders 93
Avindra Nath and Wenxue Li

2.4 Traumatic Stressors and the Psychoneuroimmunology of HIV/AIDS 99
Dan J. Stein, John A. Joska, and Kathleen J. Sikkema

3 Clinical Aspects of HIV-Related Neurocognitive Disorders 107
Nicholas W.S. Davies and Bruce J. Brew

Commentaries

3.1 Clinical Aspects of HIV-Related Neurocognitive Disorders 131
Robert Paul and Jodi Heaps

3.2 Differential Diagnosis in HIV-Associated Neurocognitive Disorders 137
Gabriele Arendt

3.3 Psychiatric Disorders and HIV 143
Glenn Treisman

3.4 Optimizing the Effectiveness of HIV Treatment as Prevention with Stimulant Users 149
Adam W. Carrico

4 Treatment of Psychiatric Disorders in HIV 157
Maria Ferrara, Ignacio P. Valero, David J. Moore, Adam F. Knight, Nichole A. Duarte, and J. Hampton Atkinson

Commentaries

4.1 Combination Anti-Retroviral Treatment and NeuroHIV 194
Charles Venuto and Giovanni Schifitto

4.2 Psychopharmacology and Psychiatric Co-morbidity 199
Mark Halman

4.3 Intervention in HIV and Psychiatry: Behavioural and Psychotherapeutic Approaches 205
Reuben N. Robbins and Robert H. Remien

5 Special Populations and Public Health Aspects 211
Francine Cournos, Karen McKinnon, Veronica Pinho, and Milton Wainberg

Commentaries

5.1 Mental Health Services for HIV in Resource-Limited Settings 235
Crick Lund

5.2 Specifying the Mental Health Context for the Development of HIV Prevention and Treatment Interventions for Men Who Have Sex with Men 240
Jessica F. Magidson and Conall OCleirigh

5.3 Following the Special Populations Home: Children and Families 245
Lucie Cluver, Mark Boyes, Mark Orkin, Lorraine Sherr, and Malega Kganakga

5.4 Gender Issues and the Burden of Disease in Women 256
Catherine Mathews and Naeemah Abrahams

Index 263