title: The effect of divalproex sodium on viral load: a retrospective review of HIV-positive patients with manic syndromes.
abstract: OBJECTIVE
  In vitro studies report that valproic acid causes an increase in HIV-1 replication. This retrospective study examines a sample of patients with HIV disease and behavioural disturbances, for which the treatment of choice is divalproex sodium (DVP), to determine whether DVP causes an increase in HIV-1 replication.
  
  
  METHODS
  A chart and database review identified 15 patients with HIV disease presenting with either 1) mania or hypomania or 2) dementia with mania or with hypomania or behavioural disturbances. HIV-1 viral load was compared before and after mood stabilizer initiation.
  
  
  RESULTS
  Eleven patients started therapy with DVP, and 4 patients declined treatment with a mood stabilizer. Nine of the 11 patients taking DVP were also receiving antiretroviral therapy. HIV-1 viral load did not increase in 6 of the 9 patients who had measurements between 1 week and 3.5 months after DVP initiation. No follow-up was available for the other 3 patients. Of the 2 patients receiving DVP but not antiretroviral medication, 1 had an increase of 0.17 log in HIV-1 viral load at 4 months. No follow-up record was available for the second patient. The 4 patients not taking DVP were all on antiretroviral therapy; viral loads in 2 of them remained nondetectable over 3 to 4 months, and 1 had an increase of 0.32 log in HIV-1 viral load at 3 months. No follow-up record was available for the fourth patient.
  
  
  CONCLUSIONS
  These preliminary data suggest that, in the presence of effective antiretroviral therapy, HIV-1 viral load appears not to be adversely affected by the administration of DVP. The results for the patients receiving DVP in the absence of antiretroviral medication remain indeterminate. Further prospective study is required.
authors.affiliation: Department of Psychiatry, University of Toronto, and St Michael's Hospital Mental Health Service, Toronto, Ontario.
authors.forename: J D
authors.initials: JD
authors.lastname: Maggi
authors.forename: M H
authors.initials: MH
authors.lastname: Halman
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000821:virology; D004359:Drug Therapy, Combination; D006679:HIV Seropositivity / Q000523:psychology / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014635:Valproic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D019562:Viral Load / Q000145:classification; D014779:Virus Replication / Q000187:drug effects*
chemical_list: D019380:Anti-HIV Agents; D018692:Antimanic Agents; D014635:Valproic Acid