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The evolution of neurobehavioural complications of HIV infection

Changes in mood, behaviour, and neurocognitive functioning can accompany infection by Type 1 Human Immunodeficiency Virus (HIV-1), the causative agent of acquired immune deficiency syndrome (AIDS). Some of these neurobehavioural phenomena reflect attempts to cope with and adapt to knowledge and complications related to a devastating, fatal illness. Others reflect the impact of biological factors on brain function. Elsewhere we have suggested the use of the terms 'psychogenic' and 'neurogenic' to allude to these two broad categories of causation of behavioural disorders (Grant & Atkinson, 1990). The neuropsychiatric disturbances that can accompany HIV infection tend to evolve in concert with the natural history of the underlying medical disorder. Fig. 1 presents the idealized relationship of the key processes underlying deterioration of cell mediated immunity (represented by declining CD4+ lymphocyte numbers), progress of medical symptomatology, mood disturbance, and appearance of neurocognitive disturbance. In general, it can be seen that the 'psychogenic' phenomena (i.e. anxiety, depression, coping difficulties) tend to be most in evidence during transition points in the illness at the time of discovery of serostatus, during appearance of medical symptoms, and as part of the transition into more serious stages of disease. Disturbance in cognitive function, thought to reflect progress of brain disease, has a low prevalence during the medically asymptomatic phase, with substantial increase during later phases of the illness.