ABSTRACT
Human Immunodeficiency Virus (HIV) has tropism for brain tissue, fostering the development of neuropsychiatric abnormalities. As patients continue to live longer and to have better treatment for their early opportunistic infections, there is more time for the development of neurologic, brain, and behavior manifestations of HIV. HIV is a medical illness and a mental status change could signal the onset of infection, trauma, drug effect, metabolic abnormality, delirium, or dementia. The use of psychotherapy and psychopharmacologic agents can help considerably to improve the quality of life of people with HIV. Medications are an important component of the treatment of patients with central nervous system manifestations of HIV disease. There are patients who for a variety of reasons cannot tolerate these medications but do respond well to other categories of medications like fluoxetine. Fluoxetine dosing should be done carefully, as in the elderly, starting with a low divided dose such as 10 milligrams four times a day and gradually titrating upward.
