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    Peer Reviewed

    Neuropsychiatric aspects of HIV-1 infection.


    A consultation on the neuropsychiatric aspects of HIV-1 infection was held at the World Health Organization (WHO) headquarters January 11-13, 1990. Of topics discussed, participants concluded that a group of conditions characterized by cognitive and motor impairment can be described. New terminology was suggested accordingly. Participants found that otherwise health HIV-1 seropositive patients were no more likely than HIV-1 seronegative patients to manifest clinically significant cognitive impairment. The serological screening of asymptomatic patients for HIV-1 in attempts to protect public safety was therefore deemed unnecessary. Hallucinations and delusions being not infrequent in AIDS and ARC patients, they may be indicative of cognitive impairment or later accompanied by symptoms pointing to diagnosis of delirium or dementia. Acute psychotic disorders outside of evidence of cognitive impairment may result as anomalies described within the text. Depressive syndrome may result outside of severe depressive episode or major depression due to recent diagnosis as HIV-1 positive and/or as the first stage of HIV-1 dementia. DIstinguishing between ARC and the above-mentioned states as the cause of this syndrome may be difficult. Consultation participants cited stress associated with HIV-1 infection or disease to be conditioned by several factors. Finally, neuropsychiatric disorders due to HIV-1 opportunistic processes were discussed. Country-level recommendations included preparing health workers for a wide range of neuropsychiatric conditions in the HIV-1 positive patient, and notifying then that otherwise healthy HIV-1 positive patients may not show clinically significant signs of cognitive impairment. Recommendations followed in urging health services to prepare for a large burden of neuropsychiatric illness in AIDS and ARC patients; governments should support services and train health workers accordingly. Pre- and post-serological testing counseling was stressed, with facility for and understanding of the special needs of HIV-1 positive patients' families and involved health staff. Research on the neurological and mental health needs of patients should be given high priority with attention given to the immediate policy and care implications. Final qualification of the difficulty involved in generalizing research findings to apply across sociocultural and geographical contexts was provided with mention in the text of a WHO multicenter study addressing this concern in its pilot phase at the time of publication. Neurological tests were designed for use in this study to be culturally nonspecific.
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