A prospective study of psychiatric aspects of early HIV disease in women.

Few studies of psychiatric morbidity associated with HIV disease have included women. The authors prospectively studied a cohort of HIV-seropositive women, none of whom had AIDS, to assess changes in their psychiatric status over time. All seropositive women admitted to the U.S. Air Force's HIV evaluation unit for comprehensive evaluations since 1987 were eligible for enrollment in an open-ended prospective study. Forty-three women without AIDS enrolled between 1987 and 1991 (83% of those eligible), 29 of whom have been interviewed at least twice. The Structured Clinical Interview for DSM-III-R and a semistructured interview were administered to assess psychiatric diagnoses, suicidality, sexual functioning, affective status, and other psychosocial variables. Women were more likely to have a psychiatric diagnosis at follow-up, largely accounted for by a substantial increase in sexual dysfunction (41% of reevaluated group). None engaged in suicidal behavior or required psychiatric hospitalization during the 86.9 woman-years of observation. High-risk sexual behavior occurred after seroconversion in at least 35% of the group, with no interval decline. Most women with early stage disease were free of major psychiatric disorders at both assessments. Many developed sexual dysfunction that impaired intimate relationships and detracted from quality of life. The psychiatric natural history of HIV infection in women appears to differ from that observed in studies of men.