James W. Dilley, M.D., Executive Director of the UCSF AIDS Health Project, Answers Some Questions About HIV/AIDS
James W. Dilley, M.D., Executive Director of the UCSF AIDS Health Project, one of the premier HIV-related mental health agencies in the country, answers some questions about HIV/AIDS and mental health.
Do drugs such as Xanax and Prozac have a negative effect on the immune system?:
Xanax is a relatively new benzodiazepine-like drug (similar to Valium and Librium, but from a chemically different class). These drugs are widely used for their anti-anxiety effects, sometimes by people with HIV disease. Laboratory studies have shown that these drugs have some effects on the functioning of immune cells, but it is unlikely that these effects are clinically significant, that is, they do not appear to affect the function or nature of the cells that make up the immune system. Concern about these drugs usually centers more on their abuse potential than on their effect on immunity.
The antidepressants Prozac, Zoloft, and Paxil are all from the class of drugs known as the selective serotonin re-uptake inhibitors (SSRIs). Studies have also suggested that fluoxetine, the chemical name of Prozac, does not affect the number of T-helper cells in HIV-infected people. While there is no specific research on SSRI effects on immunity, these drugs do not appear to materially affect the functioning of the immune system. While anti-anxiety and antidepressant medications are generally safe and well-tolerated in people with HIV disease, individuals should discuss with their physicians the possible side effects and interactions with other HIV-related medications.
For further information see:
Covelli V, Munno I, Decandia P, et al. Effects of benzodiazepines on the immune system. Acta Neurologica. 1991; 13(5): 418-423. Rabkin JG, Rabkin R, Wagner G. Effects of fluoxetine on mood and immune status in depressed patients with HIV illness. Journal of Clinical Psychiatry. 1994; 55(3) 92-97.
Dan Karasic, MD, Assistant Clinical Professor of Psychiatry at UCSF and one of AHP's attending psychiatrists at San Francisco General Hospital's AIDS Ward, contributed to this response.
My partner has just tested positive for HIV; I'm HIV-negative. I feel like I'm changing the way I relate to him. I've stopped expecting him to meet my needs and have shifted entirely to meeting his needs. Is this a normal reaction? I feel overwhelmed.
When one person in a couple tests HIV-positive, the dynamics within the couple typically shift on both a conscious and unconscious level. Beyond the immediate effects of fear and grief, having to consider the consequences of a partner's HIV infection wreaks havoc on the plans, hopes, and dreams for the future of the couple. Assumptions of longevity, of a partner always being there, of growing old together are dashed and replaced by uncertainty. Although reactions may differ, your reaction is not uncommon: with a positive test comes the very real threat of the loss of the infected partner, and, it is common that the uninfected partner feels his needs are subordinate to those of his infected partner. It is also common for the infected partner to begin treating the uninfected partner differently. Sometimes these are conscious changes, and sometimes they are not. Both partners are likely to have different expectations about the relationship and each other, and to feel overwhelmed by the crisis and by conflicting desires, needs, and responses.
In these situations, it is useful for both partners to express their concerns and fears. This facilitates communication, helps to ease tension, and enables both partners to understand each other's concerns so each can sustain and support the other. In most areas, support is available for HIV-positive and HIV-negative individuals and couples. These services include support groups, peer counseling, and individual psychotherapy-tools that can aid people who are struggling to talk about these issues to identify and resolve difficult couple dynamics, clarify confusing feelings, and confront some of the conscious and unconscious reactions that an HIV diagnosis may add to already complex couple relations.
For further discussion, see:
Michael Discepola, AHP's Coordinator of HIV-Negative Services, contributed to this response.
Is there a "normal" reaction to testing HIV-positive?
No. The reactions to receiving a positive HIV test result are as unique as each person who comes in for counseling. Ranging from shock, fear, anger, grief, despair, and confusion to relief, hope, and a commitment to "take care of oneself," reactions depend on a variety of factors. These include a person's age, culture, connection to other people who are HIV-infected, sexual practices, level of emotional support, personality style, and perhaps, most importantly, the degree to which the client was expecting a positive test result.
Those who do not expect a positive result and believe they have participated in "safe" behaviors are surprised to learn that they had not been as "safe" as they might have believed and tend to have the most difficult time. These people are shocked, angry and are frequently emotionally overwhelmed. They may become tearful and visibly upset as their usual psychological defenses crumble under the weight of the news.
Alternatively, people who do not expect a positive result may show little or no outward expression of his or her emotional response. For example, those from Asian cultures, particularly people who have recently moved to the United States, are well-known for their stoicism and may react impassively to the news of their infection.
Other people, regardless of ethnicity, may actually be in such a state of shock that they cannot immediately appreciate the meaning of the news and may experience the result "as though it was being given to someone else." While these people may be as overwhelmed as people who express strong emotions, they feel numb and exhibit no outward reaction. They appear to be "fine," but are actually delaying their emotional response-"denying" the awful meaning of the news even though they may understand it intellectually. Over time, as the intensity of the shock lessens, these people are able to begin to express their feelings, perhaps in the safety of their homes or with trusted friends. Those people who expect to receive positive test results often respond with less overall emotional intensity. They may appear to be unaffected by the news or they may briefly breakdown. It is not uncommon for some to report a mixture of sadness and relief. The relief comes from "knowing for sure what I've always suspected." These people are typically knowledgeable about HIV disease and the latest research and aware of how their actions have put them at risk, and have adapted their lifestyles to incorporate aspects of healthier living. Often, these people have a primary care physician, health insurance, and friends who are living with HIV. Receiving the test result is usually one last piece of a puzzle whose answer they already know, one last step to psychologically integrating the reality that they are HIV-infected. Antibody test counselors are trained to understand these various responses and to help people manage their emotions. They provide a knowledgeable and supportive environment where people can be helped to understand their own reactions, develop a plan for handling the news, and make relevant referrals if needed. Whether expecting a positive test result or not, no one should have to be alone when learning this kind of life-altering information.
Barbara Adler, MFCC, AHP's Director of HIV Testing Services, contributed to this response.