Risk for cognitive impairment among HIV-infected persons with bipolar disorder

Clinicians and clinical neuroscientists are aware that individuals with bipolar disorder are at greater risk for developing serious medical, psychiatric, and substance-use comorbidities as compared with the general population.(1,2) Less widely appreciated, however, is the observation that HIV infection appears to be more prevalent among persons with bipolar disorder and that both conditions pose significant risk for cognitive impairment.(3) Higher rates of HIV infection among persons with bipolar disorder should not be surprising, given that infection and transmission of HIV involves risk factors that converge with bipolar disorder (eg, impulsivity, substance abuse). These factors likely also worsen adherence to treatment for both bipolar and HIV illness, and may adversely impact health-related quality of life and therapeutic outcomes. The public health consequence may be that nonadherence to antiretroviral therapy could lead to higher rates of transmission of treatment-resistant strains of HIV that can evolve with sporadic adherence. The intersection of bipolar disorder and HIV therefore merits discussion by clinicians, researchers, and policy makers.