Comprehensive Textbook of AIDS Psychiatry Edited by Mary Ann Cohen & Jack M. Gorman. Oxford University Press. 2007. £57.00 (hb). 656pp. ISBN: 9780195304350

With two forewords and divided into ten sections with a total of 41 chapters, this volume edited by two New York-based psychiatrists aims to do justice to its title. It could have been subtitled ‘The view from the USA’, had it not been for the fact that one of its 72 contributors is based in Canada. Among the rest, the majority work in New York and a handful in Omaha, Nebraska, in California and in Florida. Unsurprisingly in view of the origin of the contributors, the overwhelming majority of the references quoted and the topics addressed are from North America and relevant to that part of the developed world. Although the level of expertise and practical knowledge of many of the authors is a great strength of this textbook, the rather narrow geographical and social context of its scope is a limitation.

There are good, succinct chapters on the epidemiology of mental disorders in people with HIV infection, anxiety disorders and suicide ideation. Chapters on HIV-associated fatigue and insomnia cover important neglected topics in a practical and well-researched way. Discussion of the effects of HIV on brain function is detailed and exhaustive, but it would have been better not to have allocated the material to five different chapters. Inevitable repetition and overlap could have been avoided and a critical evaluation of the evidence presented in a much clearer way. Two chapters dealing with severe psychiatric disorders and risk of HIV infection and transmission will be of particular interest to general psychiatrists. Reviews of medical comorbidities with mental manifestations and interventions to increase treatment adherence are practical and clear. A surprising omission concerns sexual dysfunction – no review or discussion of this very common problem in people with HIV is provided beyond a passing reference to antiretroviral use.

A very detailed and comprehensive chapter on psychopharmacological interventions and drug interactions with anti-retrovirals describes the potential risks of adding psychotropic drugs to complex medical treatments. Although a first examination of the evidence might lead some psychiatrists to a prescribing paralysis, cautious use of a limited number of safe antidepressants and other psychotropics will avoid serious harmful interactions. Two emerging topics receive attention: the mental health impact of hepatitis C, both as comorbid with HIV but also in its own right, as an infection with likely neurocognitive effects, and the mental consequences of ageing with HIV infection.

Apart from the lack of attention to the mental health impact of HIV in resource-poor countries, the discussion of ethical and legal issues is limited, so that the concerns that are often raised by psychiatrists about consent for HIV testing, capacity for medical decisions and use of compulsory psychiatric treatment are addressed only briefly.

Overall, this is a good, solid book for the medical library and for general hospital mental health teams dealing with people with HIV, but possibly too detailed for the psychiatrist in training.