ABSTRACT
The relationship between hiv, major depressive disorder and suicidal ideation is well established. For example, hiv-positive patients are seven times more likely to develop depression, and suicidal behaviour is also more prevalent. Antiretroviral therapy is known to further enhance these risks. We saw a 53-year-old patient with a depressive episode and suicidal ideation, possibly related to the use of dolutegravir/abacavir/lamivudine. We provide an overview of the literature and we present a neuro-immunological hypothesis for this psychiatric adverse event, which may occur even after months of treatment.
Subject(s)
Depressive Disorder, Major/diagnosis , HIV Infections/psychology , Suicidal Ideation , Anti-HIV Agents/adverse effects , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Comorbidity , Depressive Disorder, Major/etiology , HIV Infections/complications , HIV Infections/drug therapy , HIV-1 , Humans , Male , Middle AgedABSTRACT
In 1999 the decision was taken to start a transmural consultation service for HIV-seropositive drug users at the Consultation Office for Alcohol and Drugs [Dutch acronym: CAD] in Heerlen, the Netherlands. This consultation service was run by an AIDS consultant from Maastricht University Hospital together with the addiction physician from the CAD. In the period 1 November 1998-30 April 2002 29 HIV-seropositive drug users made use of this consultation service. Highly active antiretroviral therapy was prescribed to 23 patients during an average of 21 months (range: 4-51). Eighteen patients responded well to this therapy (viral load < 50 copies/ml) after 12-24 weeks of treatment and thereafter during 21 months. Direct observed therapy (DOT) was applied to 16 patients. Therapeutic failure due to poor compliance was observed in 3 patients. Two of them had initially been successfully treated with medication whilst under supervision but the treatment failed when they became responsible for taking their own medication. It seems that involving the Consultation Office for Alcohol and Drugs in the treatment and DOT has a favourable effect on the treatment of HIV-positive drug users.
