Updates on Antiretrovirals for the Psychiatrist: A Focus on Neuropsychiatric Side Effects from Integrase Inhibitors and Pre-Exposure Prophylaxis (Prep). Sponsored by ACLP's HIV/AIDS Psychiatry SIG

Abstract:

Antiretroviral therapy (ART) use in people with human immunodeficiency virus (HIV) is of utmost importance, as the effectiveness of the available treatments has been pivotal to redefine this infection as a manageable chronic condition. Integrase strand transfer inhibitors (INSTI), commonly known as Integrase Inhibitors, are recommended as first-line treatment of HIV infection based on their relatively safe profile. As such, many individuals with HIV infection are beginning or transferring to integrase inhibitor-based regimens. However, evidence suggests higher rates of neuropsychiatric side effects than described in phase III clinical trials, including the immediate or delayed appearance of a mood or anxiety disorder. In addition, more subtle and insidious phenomena are emerging or becoming appreciated, which often present a challenge to clinicians as symptom mimickers can sometimes appear to be a relapse of an underlying mental illness, but are reversible with the cessation of the INSTI. This panel offered by the ACLP SIG on HIV/AIDS Psychiatry will begin with a description of the potential pharmacological mechanisms of neuropsychiatric side effects of INSTIs, followed by a discussion of the most common clinical syndromes. We will then discuss cases encountered in clinical practice and the diagnostic and management challenges that arise from the use of INSTIs. Finally, we will review recent advancements in pre-exposure prophylaxis (PrEP) and the psychiatric side effects associated to these agents.





PANEL





Dr. Luís Pereira (Panel Moderator) is an assistant professor of psychiatry at Columbia University Irving Medical Center and co-chair of the HIV Psychiatry SIG.



Dr. Roberta De Oliveira is the Director of Collaborative Care in Pediatrics at the Bellevue Hospital and a Consult-Liaison Psychiatrist at the Hassenfeld Children’s Hospital at NYU Langone. She will discuss the neuropsychiatric side effects of these agents.

Dr. E. Andres Calagua Bedoya, a Consultation-Liaison psychiatry fellow at the Icahn School of Medicine at Mount Sinai and ECP co-chair of the HIV/AIDS Psychiatry SIG, will provide an overview of the potential mechanisms associated to the neuropsychiatric side effects of INSTIs.

Dr. Gabrielle Marzani, an HIV Psychiatrist at the University of Virginia will share some clinical cases and lessons from a Ryan White funded clinic after a large percentage of patients transitioned onto integrase inhibitor based regimens.



Dr. Alan Wai, an HIV and Consultation-Liaison Psychiatrist at University Health Network, Toronto, Canada, and ECP Co-Chair of the HIV Psychiatry SIG will discuss recent advances in PrEP and its relevance to the mental health practitioner.