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genetic predisposition to bipolar disorder with hiv

May 15, 2003

The symptpYes, bipolar Good mornimg Doctor: I am the adoptive mom of a great little 4yo boy. He was dx w/HIV at 6mo after a bout with pneumonia. He began rx,presently on AZT,3TC & viramune. My question is that I learned his biological mom was bi-polar, I am worried about the incidence of this being a problem for him. He is a bright, attentive kind little boy, without any behaviors problems. When do people manifest symptoms of this disorder? How likely is he to develop it? Will he be more proned to this with his hiv/meds? Finally, does hiv+ status cause changes in the brain when ones VL is non-detectable? Thank you kindly!!

Response from Dr. Horwath

Yes, children of persons with bipolar disorder are at higher risk to develop the disorder. Various studies have suggested different levels of risk, but it looks like the risk for a child if his mother has bipolar disorder is approximately 10%. Looking at it another way, he has a 90% chance of not developing the disorder.

The signs and symptoms of bipolar disorder ususally develop in adolescence or young adulthood, although some people have a later onset in their 40's.

HIV infection and antiretrovirals do not increase the risk of bipolar disorder, but there have been reports of people developing manic-like symptoms either due to HIV infection or as a reaction to medications. I have seen a patient develop a manic episode in response to treatment with efavirenz, and other mood disorder symptoms, like depression, have also been reported. However, this is not the same as bipolar disorder because the symptoms should resolve with withdrawal of the medicine.

It is not known whether HIV infection causes changes in the brain in people with a non-detectable viral load. Scientists have found evidence that HIV is present in the central nervous system of people soon after the primary HIV infection, but changes in the brain have been documented clearly only for patients with advanced AIDS, and usually with a variety of other medical complications, like opportunistic infections, high viral loads, and low CD4 T-lymphocyte counts.

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