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Chapter: Essentials of Psychiatry: Delirium and Dementia

Acquired Immunodeficiency Syndrome

The CDC reports that as of June 1, 2001, 793 026 individuals had been diagnosed as having AIDS, with over 134 000 women in-cluded in that total.

Acquired Immunodeficiency Syndrome


The CDC reports that as of June 1, 2001, 793 026 individuals had been diagnosed as having AIDS, with over 134 000 women in-cluded in that total. Nine thousand children under age 13 years have been diagnosed. Deaths from AIDS-related illnesses have reached 458 000. Worldwide, about 40 million people, including 3 million children, have AIDS. Forty-eight percent of the world-wide cases are women, and 95% of AIDS cases are in undevel-oped countries (AIDS Surveillance Report, 2002). The number of people infected is postulated to be as much as 50 to 100 times the number of people diagnosed with AIDS, and 80 to 90% of people infected have not been tested.


In the developed countries, the death rate from AIDS has been on the decline since the advent of new medication regi-mens utilizing traditional antiretrovirals and the newer protease inhibitors. These medication cocktails have also decreased the incidence of AIDS dementia complex, so that physicians are now more likely to see AIDS-related delirium secondary to infection, metabolic disarray and medication rather than traditional AIDS dementia.


In the truest sense, AIDS is not a disease but an increased susceptibility to a variety of diseases caused by loss of immu-nocompetence. It results from infection with HIV, a retrovirus that attaches to the CD4 molecule on the surface of the T4 (thy-mus-derived) lymphocyte. Then, using reverse transcriptase, the virus reverses the usual sequence of genetic information and be-comes integrated into the host cell’s DNA. The ultimate result is destruction of the T4 cell, replication of the virus, a defect in cell-mediated immunity and the development of various oppor-tunistic infections and neoplasms.


The epidemiology of HIV spectrum diseases has changed significantly in the 16 years since its identification. Initially, homosexual and bisexual men with multiple partners were the highest-risk group. Intravenous drug abusers and recipients of tainted blood products were soon added to high-risk groups. In the 1990s, the number of new infections among homosexual men decreased significantly and rates for women, intravenous drug abusers who shared contaminated needles, and infants born to infected mothers increased significantly. Intravenous drug abusers, regardless of sexual orientation, represent the fastest growing population of the newly infected people. Conversely, instances of transmission by blood products have decreased since the development of laboratory testing for HIV antibodies. The CDC has now established a reactive HIV antibody screen, presence of an opportunistic condition, and a CD41 cell count of 200 or less (normal being 1000–1500) as criteria for the di-agnosis of AIDS.


AIDS is now best considered as part of the spectrum of HIV infection. There are four stages of infection.


Stage 1: Acute Infection: Most infected persons remember no signs or symptoms at the time of the initial infection. The acute syndrome follows infection by 4 to 6 weeks and is characterized by fevers, rigors, muscle aches, maculopapular rash, diarrhea and abdominal cramps. These symptoms, often mistaken for those of influenza, resolve spontaneously after 2 to 3 weeks.


Stage 2: Asymptomatic carrier: This stage follows the acute in-fection. The patient is without symptoms for a variable amount of time. The mean symptom-free period has in-creased significantly since the disease was first identified and is now about 10 years. Most of the estimated 2 mil-lion infected Americans are at this stage. Even though these individuals are asymptomatic, they are carriers of the disease and can infect others.


Stage 3: Generalized adenopathy: In older terminology, this stage was referred to as the AIDS-related complex. It is characterized by palpable lymph nodes that persist for longer than 3 months. These nodes must be outside the inguinal area and due to no other condition except HIV.



Stage 4: Other diseases:



1.        Constitutional symptoms such as lingering fever, wasting syndromes and intractable diarrhea.


2.        Secondary infections including P. carinii pneumo-nia, cytomegalovirus retinitis, parasitic colitis, and oral esophageal thrush.


3.        Secondary neoplasms such as Kaposi’s sarcoma and B-cell lymphomas.


4.        Neurological diseases (AIDS dementia complex).


Thus, the diagnosis of AIDS is made when an infected individual develops either a CD41 cell count of less than 200 or a certain condition listed in the stages.


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