Integrative Approaches for people living with HIV/AIDS: Enhancing whole-health through ketamine, esketamine and psychedelic therapies, an HIV/AIDS SIG-sponsored symposium.

Abstract: The prevalence of psychiatric disorders and chronic pain among people living with HIV/AIDS (PLWHA) necessitates innovative treatment strategies that extend beyond conventional psychiatric care. Consultation-Liaison (C-L) Psychiatry, with its comprehensive biopsychosociocultural approach, is uniquely positioned to lead in integrating evidence-based, whole-person care strategies. In this session, our group systematically reviewed holistic strategies implemented with the assistance of ketamine/esketamine and psychedelic therapies to enhance the whole health of PLWHA, including clinical trials and case studies examining the efficacy, pharmacological properties, benefits, and limitations of ketamine/esketamine and psychedelic therapies in treating psychiatric and pain conditions among PLWHA.

Ketamine/esketamine shows promise in treating mood disorders, anxiety, PTSD, catatonia, and pain management in PLWHA, with pilot studies highlighting improved outcomes over traditional treatments such as antidepressants, benzodiazepines and opioid analgesics. Pharmacologically, ketamine's actions on dopamine, glutamate, and inflammation offer potential benefits for PLWHA with comorbid psychiatric conditions. However, considerations regarding side effects, contraindications, and medication interactions, especially with antiretrovirals and psychiatric medications, are crucial for safe implementation. Protocols for the administration of ketamine/esketamine in clinical settings, emphasizing observation times and treatment dosing, are discussed. Additionally, emerging research on psychedelics like psilocybin-assisted psychotherapy suggests potential therapeutic benefits for psychiatric conditions in PLWHA, warranting further exploration. Barriers to access these treatments, including stigma surrounding HIV status, will also be discussed.

While still in its early days of implementation, ketamine/esketamine and psychedelics are gaining attention within C-L Psychiatry to address the complex needs of PLWHA, particularly when combined with lifestyle changes, nutritional support, and complementary interventions to enhance efficacy, quality of life, and prevent relapse of comorbid conditions. By expanding the therapeutic toolkit beyond conventional psychiatric treatments, C-L Psychiatry can significantly contribute to whole-person health, offering new hope and improved quality of life for this population. Future research should focus on long-term outcomes, refining treatment protocols, and understanding the mechanisms underlying the therapeutic effects of these interventions.