Secondary mania in patients with HIV infection: Are antiretrovirals protective?

A case-control study of 19 patients with HIV-associated mania and 57 HIV-se ropositive control patients matched by CD4 cell count, age, and year of tre atment was undertaken to investigate associations with risk factors for hum an immunodeficiency virus (HIV) infection, treatment, and disease. There wa s no significant difference between groups for HIV exposure category, basel ine health status, or drugs other than antiretrovirals. Zidovudine therapy provided a significant protective effect against the development of mania, whether administered at or prior to diagnosis of mania. In a 3-year follow- up study, incident AIDS dementia was significantly more common in patients with mania, despite no apparent difference in survival between cases and co ntrols. These findings strengthen the evidence of an etiological associatio n of HIV neuropathology with AIDS mania by demonstrating a protective effec t of an antiretroviral agent able to penetrate the central nervous system.