Psychosomatics 40:529, December 1999
© 1999 The Academy of Psychosomatic Medine
CD4 Counts of HIV-Positive Patients With Cognitive Disorders in Japan
Isao Fukunishi, M.D.,
Naotsugu Hirabayashi, M.D., and
Katsuyuki Fukutake, M.D., Tokyo Metropolitan Organization for Medical Research, Tokyo Institute of Psychiatry, Departments of Neuropsychiatry and Clinical Pathology, Tokyo Medical College, Tokyo, Japan
Key Words: Letters to the Editor • HIV • Cognitive Disorders
TO THE EDITOR: The total number of human immunodeficiency virus (HIV)-positive patients is still relatively low in Japan (4,312 HIV-positive patients and 1,427 acquired immunodeficiency syndrome [AIDS] patients as of February 1999),1 compared with the United States, and the majority of HIV-positive patients are concentrated in the Tokyo metropolitan area. Therefore, consultation-liaison psychiatrists who belong to the reserved general hospitals in Tokyo dealing with HIV-positive patients frequently see associated psychiatric problems, including mood and cognitive disorders. We examined the incidence rate of psychiatric disorders over 1 year (1997) and the relationship between CD4 counts and cognitive disorders in a sample of 179 HIV-positive patients consisting of 106 patients without and 73 patients with AIDS in Tokyo, Japan.
Eleven of the 40 reserved general hospitals in the Tokyo metropolitan area dealing with HIV-positive patients voluntarily participated in this study. The subjects were 179 HIV-positive patients (157 men and 20 women) and included 106 patients without and 73 patients with AIDS who were admitted to the participating general hospitals.
The sample size was about 4.2% of all HIV-positive patients and 5.1% of all AIDS patients living in Japan. This research constitutes the largest psychiatric study of HIV-positive patients in Japan to date.
After obtaining informed consent, psychiatric interviews were performed to examine the presence or absence of psychiatric disorders over 1 year. Psychiatric diagnoses were performed by using DSM-IV criteria based on the discussion of two liaison psychiatrists or psychologists. The psychiatric follow-up period was about 1 year.
The total incidence rate of psychiatric disorders was 29.6% (53 of 179 patients) in all HIV-positive patients. The incidence rate of psychiatric disorders was significantly higher for the patients with AIDS (47.9%) than for the patients without AIDS (18.9%) ( 2=16.1, df=1, P=0.001). This difference appears to be due to the dramatic increase in cognitive disorders after the onset of AIDS.
Among psychiatric disorders, the incidence rates for mood disorders and cognitive disorders ranked first (23.4%) and second (23.1%), respectively. The remaining psychiatric disorders were adjustment disorder (2.2%), substance abuse disorders (2.2%), and others (0.5%). No significant difference was observed between the incidence rates of mood disorders in the patients with (15.1%) and without AIDS (13.7%). The incidence rate of cognitive disorders was significantly higher for the patients with AIDS (28.8%) than for the patients without AIDS (1.1%) (2=23.3, df=1, P=0.001).
CD4 counts were found to be related to the incidence of cognitive disorders. A total of 1.8% (1 of 112) of the patients with CD4 counts less than 500/µl, 28.8% (21 of 73) of patients with counts less than 200/µl, over 40% (18 of 45) of the patients with counts less than 100/µl, and more than 45% (16 of 35) of the patients with counts less than 50/µl were diagnosed with cognitive disorders. The increase in the incidence rate of cognitive disorders with lower CD4 counts was statistically significant (2=52.8, df=3, P=0.0001). This finding suggests the possibility that the CD4 count may be a biological indicator predicting the manifestation of cognitive disorders, although other medical and psychiatric factors are also related to the development of cognitive disorders.2
REFERENCES
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AIDS Committee of Japan: Informations in HIV-positive patients on Tokyo Metropolitan. Hand-in-hand AIDS Tokyo (newsletter) 1999, 7, pp. 1–2
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Stern Y, Liu X, Marder K, et al: Neuropsychological changes in a prospectively followed cohort of homosexual and bisexual men with and without infection. Neurology 1995; 45:467–472[Abstract/Free Full Text]
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