Effect of Lithium Carbonate in HIV-Infected Patients

Case Report

Ann Depress Anxiety. 2014;1(1): 1004.

Effect of Lithium Carbonate in HIV-Infected Patients

Athar Halaby1*, Jacques Mokhbat2 and Wadih J Naja1

1Department of Psychiatry, Lebanese University, Belgium

2Department of Medicine, Lebanese American University

*Corresponding author: Athar Halaby, Psychiatry, Faculty of Medical Sciences, Lebanese University, Mount Lebanon Hospital, Belgium

Received: Aug 05, 2014; Accepted: Aug 16, 2014; Published: Aug 18, 2014

Introduction

The presence of a strong relationship between HIV infection and psychiatric disorders has been well established. This co morbidity is due to several reasons, mainly the action of the virus on the brain, in addition to stigmatization, and coping with a serious medical illness. The prevalence of bipolar disorder can be as high as 78% in HIV patients [1].

Despite the current trend in favor of atypical antipsychotics in the armamentarium of bipolar disorders [2] lithium is still considered as a first line agent [3]. It has been known that lithium stimulates pluripotent stem cell and improves neutropenia [4].

HIV binds to helper T cells and leads to a low level of CD4 T cells by direct viral killing of infected cells, increased rate of apoptosis, or cytotoxic lymphocytes destruction of infected CD4 cells. It has been recently found that lithium could stimulate CD4 T cell production in IV infected patients [3].

Case 1

A 30-year-old, HIV, homosexual male presented to a psychiatric office after having a 4 weeks history of low mood, lack of interest, and suicidal thoughts.

The patient was diagnosed with HIV four years earlier, and consequently received appropriate medical care, including highly active antiretroviral therapy. His current regimen comprised the following range of drugs: lamuvidine 150 mg twice daily, tenofovir disoproxil fumarate 300 mg once daily, and efavirenz 600 mg once daily.

However, the patient psychiatric history had begun earlier. At the age of 22 he was diagnosed with depression by his primary care physician and well responded to sertraline 50 mg once daily for a period of 12 months.

The patient mentions that at the age of 24 he experienced a state of euphoric mood for a short period of time, during which he had multiple unprotected sexual affairs. This he believes was the underlying cause of his acquiring the infection.

Around the age of 29, the patient psychological state started to deteriorate, revealing increased anxiety, progressively affecting his social and occupational life, he then consults a psychiatrist after nearly four weeks history of depressed mood and suicidal thoughts.

Based on the history, and using the SCID-I as an instrumental tool, he was diagnosed with bipolar disorder type II, and lithium carbonate 600 mg twice daily was started and reaching a therapeutic level of 0,9 mmol/l. Four months following therapy, his T-cell count showed for the first time improvement (Table 1).

Table 1: Summary of the T-cell count





  

    
 

    
Before lithium

    
After lithium

  

  

    
CD4

    
303 cells/mm³

    
675 cells/mm³

  

  

    
CD8

    
306 cells/mm³

    
667 cells/mm³

  

  

    
CD4/CD8

    
0.99 cells/mm³

    
1.01 cells/mm³

  










Table 1:  Summary of the T-cell count

Discussion

As shown in Table 1, the patient experienced a marked improvement (number has doubled) in the T-cell count after six months of lithium carbonate introduction. To noteh that the patient has been treated 2 years before with antiretroviral medications, and it the first time that he showed improvement in his T-cell count. The ratio of CD4 to CD8 cells is a measure of how balanced the immune function is. In HIV positive people not responding to treatment the ratio drops over time until there are more CD8 cells than CD4 cells [5]. (as shown in the table before the introduction of lithium).

Lithium, in addition to its being a mainstay in the treatment of bipolar disorder, it has shown significant results in boosting the CD4 count in HIV infected patients as reported in a study by Herbert et al [6]. Similarly, the outcome of our case comes in concordance with the reported study, highlighting the stimulating effect of lithium on the CD4 count.

References

  1. Perretta P, Akiskal HS, Nisita C, Lorenzetti C, Zaccagnini E, Della Santa M, et al. The high prevalence of bipolar II and associated cyclothymic and hyperthymic temperaments in HIV-patients. J Affect Disord. 1998; 50: 215-224.
  2. Yatham LN. Atypical antipsychotics for bipolar disorder. Psychiatr Clin North Am. 2005; 28: 325-347.
  3. Richman CM, Makii MM, Weiser PA, Herbst AL. The effect of lithium carbonate on chemotherapy-induced neutropenia and thrombocytopenia. Am J Hematol. 1984; 16: 313-323.
  4. Jordan WC. Use of lithium in maintaining T-cell functions in persons with documented acquired immunodeficiency syndrome. J Natl Med Assoc. 1992; 84: 1044-1046.
  5. Torti C, Prosperi M, Motta D, Digiambenedetto S, Maggiolo F, Paraninfo G, et al. Factors influencing the normalization of CD4+ T-cell count, percentage and CD4+/CD8+ T-cell ratio in HIV-infected patients on long-term suppressive antiretroviral therapy. Clin Microbiol Infect. 2012; 18: 449-458.
  6. Herbert V, Hirschman S, Jacobson J. Lithium for zidovudine-induced neutropenia in AIDS. JAMA. 1988; 260: 3588.

Citation: Halaby A, Mokhbat J and Naja WJ. Effect of Lithium Carbonate in HIV-Infected Patients. Ann Depress Anxiety. 2014;1(1): 1004. ISSN:2381-8883