Amelia Sim and Lai Gwen Chan
Objective: To illustrate clinical challenges, explore existing literature and identify knowledge gaps in the management of neuropsychiatric issues beyond neurocognitive disorders in HIV patients. Methods: Three case vignettes from a consultation-liaison psychiatry setting in a general hospital were collated and summarised into a case series. Clinical questions were identified from each vignette and pertinent literature reviewed to aid a further discussion of management issues. Results: The first case vignette discusses the potential of a multi-dimensional approach to the formulation of a HIV patient with emergent psychiatric and cognitive symptoms. In the second, pharmacological treatment of a HIV patient with a severe manic relapse of Bipolar 1 Disorder and active TB disease is discussed. Lastly, the collective effects of severe Traumatic Brain Injury (TBI) and HIV infection superimposed on that of an ageing brain are described. Iatrogenic risks of polypharmacy in an elderly HIV patient are further explored. Conclusion: The practical aspects of clinical challenges regarding the management of HIV patients are multi-fold and most apparent in a real-world setting. Existing literature does not yet adequately address the diagnostic dilemmas and pharmacological complexities faced. The management of other neuropsychiatric manifestations in a HIV patient remains a crucial field to be explored.
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