PsychEd Episode 57: HIV psychiatry with Dr. Adriana Carvalhal and Dr Leigh Van Den Heuvel

PsychEd: educational psychiatry podcast

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers HIV/AIDS psychiatry with special guests from two international settings to provide complementary perspectives on HIV psychiatry. Dr. Adriana Carvalhal, HIV Psychiatrist and Staff Psychiatrist at Scarborough Health Network in Canada and Dr. Leigh Van Den Heuvel, Psychiatrist and Associate Professor in the Department of Psychiatry, at Stellenbosch University in South Africa.

The learning objectives for this episode are as follows:

By the end of this episode, you should be able to…

1. Understand the unique mental health needs of people living with HIV and the bidirectional relationship between HIV and mental health

2. Identify HIV-specific mental health disorders and how to screen for these conditions

3. Outline the overall approach to treatment for HIV patients with mental health disorders

Guests: Dr. Adriana Carvalhal and Dr Leigh Van Den Heuvel

Produced by: Saja Jaberi (MD), Kate Braithwaite (MD) and Gaurav Sharma (PGY5)

Hosts: Kate Braithwaite (MD) and Gaurav Sharma (PGY5)

Audio editing by: Gaurav Sharma (PGY5)

Show notes by: Saja Jaberi (MD) and Gaurav Sharma (PGY5)

Conflicts of Interest: Neither of our guests nor hosts have declared any conflicts of interest related to this topic. Generic names are used for all medications referenced.

Contents:

• Introduction - 0:19

• Learning objectives - 3:52

• The bidirectional relationship between HIV and psychiatric illness - 4:24

• Prevalence of psychiatric illness in HIV - 9:56

• Screening for psychiatric illness in HIV populations - 12:11

• HIV Associated Neurocognitive Disorder (HAND) - 19:27

• Diagnostic Criteria - 20:19

• Clinical Presentation & Etiology - 23:03

• Risk Factors - 26:56

• Screening Tools - 32:06

• Treatment - 36:59

• HIV Psychiatry case example - 39:48

• Navigating the differential diagnosis - 41:44

• Initial management & addressing comorbidities - 44:30

• Drug-drug interactions between antiretroviral and psychiatric medications - 48:04

• Review of learning objectives & final thoughts - 52:04

• Outro - 55:55

Resources:

1. Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com)

2. Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2020 - Canada.ca

3. HIV and Clinical Depression

4. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-Anxiety-2012.pdf

5. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-CognitiveDisorder-2012.pdf

6. International HIV Dementia Scale (IHDS) - Mental Health Screening - National HIV Curriculum (uw.edu)/

7. Liverpool HIV Interactions (hiv-druginteractions.org)

References:

• Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843.

• Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843.

• Awori V, Mativo P, Yonga G, Shah R. The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus. South Afr J HIV Med. 2018 Apr 12;19(1):674. doi: 10.4102/sajhivmed.v19i1.674. PMID: 29707383; PMCID: PMC5913780.

• Bloch M, Kamminga J, Jayewardene A, Bailey M, Carberry A, Vincent T, Quan D, Maruff P, Brew B, Cysique LA. A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review. Clin Infect Dis. 2016 Sep 1;63(5):687-693. doi: 10.1093/cid/ciw399. Epub 2016 Jun 19. PMID: 27325690; PMCID: PMC4981762.

• Clinical Care Guidelines for Adults and Adolescents living with HIV in Ontario, Canada. Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com)

• Core Concepts - Screening for Mental Health Conditions - Basic HIV Primary Care - National HIV Curriculum (uw.edu)

• Cysique LA, Casaletto KB, Heaton RK. Reliably Measuring Cognitive Change in the Era of Chronic HIV Infection and Chronic HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci. 2021;50:271-298. doi: 10.1007/7854_2019_116. PMID: 31559600.

• EACS Guidelines version 11.1, October 2022.

• Joska JA, Witten J, Thomas KG, Robertson C, Casson-Crook M, Roosa H et al. A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa. AIDS and behavior. 2016 Aug 1;20(8):1621-1631. doi: 10.1007/s10461-016-1316-y

• Kolakowska A, Maresca AF, Collins IJ, Cailhol J. Update on Adverse Effects of HIV Integrase Inhibitors. Curr Treat Options Infect Dis. 2019;11(4):372-387. doi: 10.1007/s40506-019-00203-7. Epub 2019 Nov 16. PMID: 33380904; PMCID: PMC7758219.

• Robbins RN, Scott TM, Gouse H, Marcotte TD, Rourke SB. Screening for HIV-Associated Neurocognitive Disorders: Sensitivity and Specificity. Curr Top Behav Neurosci. 2021;50:429-478. doi: 10.1007/7854_2019_117. PMID: 32677005.

• Rubin LH, Maki PM. Neurocognitive Complications of HIV Infection in Women: Insights from the WIHS Cohort. Curr Top Behav Neurosci. 2021;50:175-191. doi: 10.1007/7854_2019_101. PMID: 31396894.

• Southern African HIV Clinicians Society. Management of mental health disorders in HIV-positive patients. S Afr J HIV Med 2013; 14(4): 155 - 165

• Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6;73(11):e3572-e3605. doi: 10.1093/cid/ciaa1391. Erratum in: Clin Infect Dis. 2021 Dec 08;: Erratum in: Clin Infect Dis. 2022 Nov 30;75(11):2052. PMID: 33225349.

• Turjanski, N., & Lloyd, G. (2005). Psychiatric side-effects of medications: Recent developments. Advances in Psychiatric Treatment, 11(1), 58-70. doi:10.1192/apt.11.1.58

• Wang Y, Liu M, Lu Q, Farrell M, Lappin JM, Shi J, Lu L, Bao Y. Global prevalence and burden of HIV-associated neurocognitive disorder: A meta-analysis. Neurology. 2020 Nov 10;95(19):e2610-e2621. doi: 10.1212/WNL.0000000000010752. Epub 2020 Sep 4. PMID: 32887786.

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

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