We are pleased to introduce this special issue of CNS Spectrums on neuropsychiatry and human immunodeficiency virus infection. The study of psychiatric manifestations of HIV has been at the forefront of research since the early 1980s. Although information has accumulated in the past 20 years, there is still a great deal to be learned. This issue includes four comprehensive reviews of the literature in the area of HIV research. The first two papers outline the prior research examining the prevalence and effects of psychiatric symptoms in HIV-positive (HIV+) individuals. The other papers summarize the research examining the effectiveness of pharmacologic and nonpharmacologic interventions in treating these psychiatric symptoms. All four articles consider the impact of these psychiatric symptoms (or their treatments) on both the psychological and physical health of HIV+ individuals. They also help delineate some of the underlying physiologic mechanisms involved in this process that perhaps may subsequently influence the course of HIV disease.

Jane Leserman, PhD, reviews and evaluates the literature on the impact of stressors, depression, and the use of specific adverse coping strategies on alterations in immune function and disease progression among HIV+ individuals. Leserman describes a number of findings generated from the Coping in Health and Illness Project and points out that there is substantial evidence that stressful life events, depressive symptoms, and passive coping strategies can lead to immune impairments during HIV disease. She discusses some of the underlying physiological mechanisms, particularly alterations in the hypothalamic-pituitary-adrenal axis, which might mediate the relationship between psychosocial factors, immune system functioning, and disease status. The author concludes that by further understanding the impact of stress, depression, adverse coping strategies, and alterations in hormonal systems on immune function, researchers will develop a greater account of how these important factors may influence HIV progression and survival.