Mood Disorder Due to Human Immunodeficiency Virus: Yes, No, or Maybe?
The potential for secondary (biological or psychological) mood disorders would seem to be heightened in human immunodeficiency virus (HIV) for many reasons. HIV infection is associated with lethal, multisystem illness related to profound immune dysregulation; infection involves the central nervous system (CNS) shortly after infection and leads to substantial neurocognitive impairment even in the absence of other physical evidence of disease. Psychological forces at work include social stigimitization of unparalleled proportion for the modern era, combined with bereavements of epidemic proportions, Nevertheless, it is misleading to attribute to HIV itself-or to its psychological and social consequences-all episodes of mood disorder. Preinfection rates of major depression are high in groups at greatest risk for HIV. Rates of "current" major depression approach 10%, but perhaps 50% of affected individuals have preinfection evidence of mood disorder. Mania is relatively rare, with an overall prevalence less that 1%. "Subsyndromic" mood disorder is understudied, but may effect an important minority of individuals. Given current advances in neuromedical evaluation, neuropsychological assessment, and rigorous psychiatric criteria, it is likely that study of secondary mood disorders in HIV can contribute to important advances in our understanding of brain-behavioral relationships.