For persons with HIV and AIDS, a thorough and comprehensive assessment has far-reaching implications not only for compassionate, competent, and coordinated care but also for adherence to medical treatment and risk reduction, as well as public health. Primary physicians, HIV specialists, as well as psychiatrists and other mental health professionals can play an important role in preventing the spread of HIV infection. Psychiatric disorders are associated with inadequate adherence to risk reduction, medical care, and antiretroviral therapy. While adherence to medical care for most medical illnesses has major meaning to patients, loved ones, and families, adherence to medical care for HIV and AIDS has major implications for reduction of HIV transmission and prevention of emergence of drug-resistant HIV viral strains (Cohen and Chao, 2008). Many persons with HIV and AIDS have psychiatric disorders (Stoff et al., 2004) and can benefit from psychiatric consultation and care. The rates of HIV infection are also higher among persons with serious mental illness (Blank et al., 2002), indicating a bidirectional relationship. Some persons with HIV and AIDS have no psychiatric disorder, while others have a multiplicity of complex psychiatric disorders that are responses to illness or treatments or are associated with HIV/AIDS (such as HIV-associated dementia) or multimorbid medical illnesses and treatments (such as hepatitis C, cirrhosis, end-stage liver disease, HIV nephropathy, end-stage renal disease, anemia, coronary artery disease, and cancer). Persons with HIV and AIDS may also have multimorbid psychiatric disorders that are co-occurring and may be unrelated to HIV (such as posttraumatic stress disorder, or PTSD, schizophrenia, and bipolar disorder). The complexity of AIDS psychiatric consultation is illustrated in an article (Freedman et al., 1994) with the title “Depression, HIV Dementia, Delirium, Posttraumatic Stress Disorder (or All of the Above).” Comprehensive psychiatric evaluations can provide diagnoses, inform treatment, and mitigate anguish, distress, depression, anxiety, and substance use in persons with HIV and AIDS. Furthermore, thorough and comprehensive assessment is crucial because HIV has an affinity for brain and neural tissue and can cause central nervous system (CNS) complications even in healthy seropositive individuals. Because of potential CNS complications as well as the multiplicity of other severe and complex medical illnesses in persons with HIV and AIDS (Huang et al., 2006), every person who is referred for a psychiatric consultation needs a full biopsychosocial evaluation.
Coronary Vasculopathy (CV) is Common in Children with End-Stage Perinatally-Acquired HIV Infection: A Study of 18 Autopsy Cases.† 693
