Psychiatric Treatment of Persons With HIV/AIDS: An HIV-Psychiatry Consensus Survey of Current Practices Oliver Freudenreich, M.D., FAPM, Harold W. Goforth, M.D., FAPM Kelly L. Cozza, M.D., FAPM, Matthew J. Mimiaga, Sc.D., M.P.H. Steven A. Safren, Ph.D., APBB, Grace Bachmann, B.A. Mary Ann Cohen, M.D., FAPM Background: Only sparse evidence from controlled clinical trials is available to guide the psy- chiatric treatment of persons with HIV/AIDS. Objective: The authors assessed and determined current treatment trends in AIDS psychiatry. Method: Members of the Organization of AIDS Psychiatry (OAP) participated in a web-based survey. Results: Of 159 members, 62 (39%) re- sponded to the survey. Consensus emerged regarding first-line treatment for depression (escitalo- pram/citalopram), for psychosis and secondary mania (quetiapine), and for anxiety (clonaz- epam). Conclusion: Consensus statements can serve as a preliminary step toward providing some standardization of care for persons with HIV/AIDS. (Psychosomatics 2010; 51:480 – 488) I nfection with the human immunodeficiency virus (HIV) remains at epidemic levels, and psychiatric comorbidity is common with this disease. Some studies have suggested psychiatric comorbidity rates of 50% and more. 1–3 Pro- viding psychiatric care for persons with HIV and AIDS is considerably complicated by multimorbid medical and psychiatric illnesses in addition to the psychosocial burden and stigma of HIV/AIDS, the high prevalence of difficult- to-treat psychiatric problems (e.g., cognitive disorders), the high prevalence of HIV in marginalized groups (e.g., prisoners, patients with severe psychiatric illnesses, homo- sexual and racial/ethnic minority populations), psychiatric side effects of medical treatments, and possible interac- tions between psychiatric and HIV medications. 4 Psychiatric disorders such as depression in persons with HIV infection are associated with decreased quality of life, decreased adherence to care, faster disease progres- sion, and increased mortality. 5,6 AIDS psychiatry has an important role to play in improving adherence to important self-care behaviors, such as risk-reduction, medical care, and treatment with combination antiretroviral therapy (CART), all of which may be harder to maintain in indi- viduals with psychiatric comorbidity. 7 Perhaps in recog- nition of these important roles, AIDS psychiatry has emerged as a subspecialty of psychosomatic medicine. There is a growing body of AIDS psychiatry literature now comprising two textbooks (one by Fernandez and Ruiz 8 and another by Cohen and Gorman; 9 [see review in this issue]) numerous book chapters, and thousands of articles. AIDS psychiatry has been an important subsec- tion of the American Board of Psychiatry and Neurology Subspecialty Board Examination in Psychosomatic Med- icine since 2005, when the first examination was given, after the recognition of Psychosomatic Medicine as an Received May 8, 2009; revised May 29, 2009; accepted June 9, 2009. From the Dept. of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA (OF, MJM, SAF); Dept. of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (HWG); Durham Veterans Affairs Medical Center, Depts. of Psychiatry, and GRECC–Div. of Palliative Medicine, Durham, NC; Dept. of Psy- chiatry, Uniformed Services University, Bethesda, MD (KLG); Academy of Psychosomatic Medicine (GB); and Mount Sinai School of Medicine, New York, NY (MAC). Send correspondence and reprint requests to Oliver Freudenreich, M.D., Freedom Trail Clinic, 25 Staniford, St., Bos- ton, MA 02114. e-mail: ofreudenreich@partners.org © 2010 The Academy of Psychosomatic Medicine 480 http://psy.psychiatryonline.org Psychosomatics 51:6, November-December 2010