J Neuropsychiatry Clin Neurosci 11:475-480, November 1999
© 1999 American Psychiatric Press, Inc.
Secondary Mania in Patients With HIV Infection
Are Antiretrovirals Protective?
Anne M. Mijch, M.B.B.S., Dip. Epidem. and Biostats., F.R.A.C.P.,
Fiona K. Judd, M.D., D.P.M., F.R.A.N.Z.C.P.,
Constantine G. Lyketsos, M.D.,
Steve Ellen, M.B.B.S., F.R.A.N.Z.C.P. and
Alex Cockram, M.B.B.S., F.R.A.N.Z.C.P.
Received July 9, 1998; revised March 15, 1999; accepted January 25, 1999. From the AIDS Clinical Service, Department of Infectious Diseases and Clinical Microbiology, Alfred Hospital, Melbourne Victoria, Australia; the University of Melbourne, Department of Psychiatry, Melbourne Victoria, Australia; the AIDS Psychiatry Service and Neuropsychiatry and Memory Group, The Johns Hopkins Hospital, Baltimore, Maryland; and the HIV Psychiatry Service, Fairfield Hospital, Yarra Bend Road, Fairfield Victoria, Australia. Address correspondence to Dr. Mijch, Department of Infectious Diseases, Alfred Hospital, Prahran Victoria, Australia 3181; e-mail: a.mijch{at}alfred.org.au
A case-control study of 19 patients with HIV-associated mania and 57 HIV-seropositive control patients matched by CD4 cell count, age, and year of treatment was undertaken to investigate associations with risk factors for human immunodeficiency virus (HIV) infection, treatment, and disease. There was no significant difference between groups for HIV exposure category, baseline health status, or drugs other than antiretrovirals. Zidovudine therapy provided a significant protective effect against the development of mania, whether administered at or prior to diagnosis of mania. In a 3-year follow-up study, incident AIDS dementia was significantly more common in patients with mania, despite no apparent difference in survival between cases and controls. These findings strengthen the evidence of an etiological association of HIV neuropathology with AIDS mania by demonstrating a protective effect of an antiretroviral agent able to penetrate the central nervous system.
Key Words: AIDS/HIV • Mania • Zidovudine
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