Épisode Psychotique Aigu Révélateur d’une Atteinte Neuropsychiatrique Associée au VIH à l’Hôpital d’Instruction des Armées d’Akanda (Gabon): Acute Psychotic Episode Indicating an HIV-Associated Neuropsychiatric Disorder at the Akanda Military Teaching Hospital (Gabon)

Abstract

Psychiatric manifestations associated with HIV infection are varied and can present a diagnostic challenge, particularly in immunocompromised patients. We report a case of an acute psychotic episode associated with HIV infection in a patient who was not receiving regular care. The patient was a 43-year-old woman who had been living with HIV for 11 years and had been adhering to her antiretroviral treatment irregularly; she was admitted for progressive psychomotor agitation that had been developing over the previous two weeks. The psychiatric assessment revealed persecutory delusions, logorrhoea and hetero-aggression. A brain CT scan and cerebrospinal fluid analysis were normal. Immunovirological testing showed a CD4 lymphopenia of 186 cells/mm³ and a viral load of 58 copies/mL. Given the severe agitation, sedation with intramuscular ketamine was required. The patient’s condition stabilised psychiatrically on haloperidol, with a resumption of antiretroviral therapy and a reduction in delusions. Acute psychotic episodes associated with HIV can occur at an advanced stage of immunosuppression and require urgent multidisciplinary management involving psychiatrists, infectious disease specialists and emergency physicians.