MOOD DISORDERS IN HIV-INFECTION

Major depression and mania have increased prevalence in HIV-infected p atients, particularly in clinical settings and at later stages of dise ase. Varied rates of major depression have been reported but differenc es in definition, methods of study, and population may partly explain these differences. We describe the clinical characteristics, assessmen t and treatment of mood disorders in HIV-infected patients, with empha sis on aspects specific to the setting of HIV infection. Diagnosis and treatment are complicated by medical complexity, stigma and psychosoc ial stress. Treatment is associated with clinical improvement. Mood di sorders are associated with impulsivity, substance abuse, hopelessness , and demoralization, all of which may increase risk for HIV infection . Also, HIV-associated subcortical damage may be a risk factor for moo d disorders, which are increased in late stage HIV infection. We discu ss the data supporting the thesis that both of these factors may be at work in producing the high rates of mood disorders seen, and speculat e that aggressive treatment of mood disorders may improve outcome and risk behaviors in HIV-infected patients.