AIDS

Introduction

Between 1981 and 2005, nearly one million individuals living in America were diagnosed with acquired immune deficiency syndrome (AIDS) (Centers for Disease Control; CDC, 2005). Approximately 40,000 individuals acquire the human immunodeficiency virus (HIV) each year (CDC, 2005). To understand the characterization of HIV/AIDS, one must be aware of the HIV-infection classification system that is frequently utilized in the literature evaluating participants with HIV/AIDS. The published system for staging HIV illness includes two primary criteria; the presence or absence of an AIDS-defining condition and a measure of immune suppression, CD4 T-lymphocyte cell count (Abramson, 42). Group A status is characterized by asymptomatic HIV-seropositive individuals with a CD4 count greater than 500 (normal CD4 count in adults range from 500 to 1,500 cells per cubic millimeter of blood; American Cancer Society, 2006). Group B status is comprised of asymptomatic and symptomatic HIV-seropositive individuals with a CD4 cell count between 200 and 500, without an AIDS defining illness. Individuals meeting Group A or Group B criteria are referred to as HIV-seropositive. Group C classification is for those with a CD4 cell count below 200 or the presence of an AIDS defining illness (e.g., Pneumocystis carinii Pneumonia, Kaposi's sarcoma, etc.). An individual in Stage C is classified as having AIDS. With treatment advances in the age of highly active antiretroviral treatment (HAART), HIV/AIDS has evolved from a terminal illness to a chronic illness (Irwin, 109).

Discussion

HIV-infection is known to have neurological and neuropsychiatric consequences (Rhodes, 297). HIV-infection negatively impacts the NP domains of executive functions, psychomotor speed, speed of information processing, attention, learning and working memory, and verbal fluency (Quinn, 921). It has been estimated that 30-50% of HIV-seropositive individuals will develop some form of neurocognitive or neurobehavioral disturbance (Paul, 615). The impact of these neurological insults can range from barely detectable and with no appreciable functional impact on daily living to HIV-associated dementia's global impairment (Herdt, 215).

Beyond neuro-cognitive abilities, psychiatric function also impacts an individual's ability to successfully complete tasks of daily living. Neuropsychiatric functioning is not spared in HIV-infection. Depression is one of the most common psychiatric diagnoses associated with HIV-infection. It has been estimated that one-third of AIDS patients have had at least one episode of Major Depression (Doll, 65), and that individuals who are HIV-seropositive have greater experience with depressive symptoms and depressive disorders compared to the general population (Corey, 23). There is discussion as to whether depression hastens HIV disease progression, and if depression is a social or biological response to acquiring HIV. Some studies have failed to find a significant relationship between HIV-infection and depression (Abramson, 42).

At the same time, depression symptoms, such as fatigue and anhedonia, can also be symptoms of HIV-infection and HIV treatment. An additional confounds in analyzing the relationship between depression (not HIV) symptoms and HIV-infection is that measures of depressive symptomology range from self-report to gold-standard psychiatric interviews (Irwin, 109). To resolve this, it has been suggested that neuromedical and NP evaluations be conducted along with psychiatric interviews (Rhodes, 297), and ...