The extent to which addiction fuels IDU is the most obvious link between psychiatric disorders and HIV transmission. Kral et al. (1998) estimated an overall HIV infection rate among U.S. IDUs of 13%, with wide geographic variability between cities in the East (where rates exceed 40%) and in the Midwest and West (where rates generally are under 5%). Yet many studies of this population did not obtain AOD use disorder diagnoses, so summarizing across studies to generalize rates of HIV infection for specific diagnostic groups is methodologically problematic. People discharged from general hospitals who had documented AOD use disorders were twice as likely to be HIV infected as those without AOD use disorders (Stoskopf et al., 2001). Studies of people admitted to treatment for primary alcohol abuse or dependence reported HIV infection rates of 5% to 10.3% (Avins et al., 1994; Mahler et al., 1994; Woods et al., 2000), and these rates are 10 to 20 times higher than those among the general population (McQuillan et al., 1997).
An overview of the literature suggests that the patho-physiology of psychosis in HIV infection is complex, and a multifactorial etiology of psychotic symptoms is likely in many cases. There are many reports of psychotic symptoms in HIV-infected persons in the absence of concurrent substance abuse, iatrogenic causes, evidence of opportunistic infection or neoplasm, or detectable cognitive impairment. A common clinical feature of new-onset psychosis in HIV-infected patients is the acute onset of symptoms. Estimates of the prevalence of new-onset psychosis in HIV-infected patients vary widely, from less than 0.5% to 15%, (Navia et al., 1986; Halstead et al., 1988;
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