Use of HIV and Psychotropic Medications among Persons with Serious Mental Illness and HIV/AIDS

Abstract

Persons with serious mental illness (SMI) have higher rates of co-morbid HIV disorders compared to the general population. There are concerns that the SMI/HIV population may be receiving fewer HIV and psychotropic medications due to problems of access and concerns by providers associated with following complex medication regimes. The purpose of this study was to examine any disparity in medication treatment of the SMI/HIV population by comparing medication use and continuity of prescription fills to groups that had HIV or SMI only versus those with SMI/HIV. Study participants were adult Medicaid recipients aged 19-64 with serious mental illness and HIV receiving services in Philadelphia from 2002 through 2003. Differences between the groups in case mix characteristics, medication use rates, and continuity of psychotropic and antiretroviral medication use were compared using Chi-square, t-tests of significance, and logistic regression. Co-morbid individuals were as likely to have filled prescriptions for psychotropic and antiretroviral medications as those with a single disorder and equally persistent in their continuity of antiretroviral medication refills as those with HIV only. However, persons with co-morbid condition had lower continuity of psychotropic medication use compared to those with SMI only. Our findings suggest the need to develop an integrated medical and behavioral healthcare model to improving coordination and treatment for patients with co-occurring disorders. Future research is warranted to investigate the reasons for the discrepancy in continuity of psychotropic adherence for the SMI/HIV population.

Undertreatment of human immunodeficiency virus in psychiatric inpatients: a cross-sectional study of seroprevalence and associated factors

“…Patients with a triple diagnosis are less likely to receive treatment for their mental illness or for their substance abuse disorder 23. In addition, the co-occurrence of the three diagnoses is associated with decreased receipt of highly active antiretroviral therapy (HAART) and viral suppression,24 and decreased adherence to treatment 25,26. Our results support these concerns.…”

“…Only 14 of the 25 (56%) HIV-infected patients received antiretroviral therapy, even though most of these patients had been identified as HIV-positive more than 6 months prior to the study and 12 patients had been HIV-positive for over 7 years. Therefore, it has been suggested that an integrative approach combining HIV, substance abuse, and mental health treatment might improve outcomes in this population 24,26. Unfortunately, the results from The HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, which evaluated the cost-effectiveness of integrated HIV primary care, mental health, and substance abuse services among triply diagnosed patients, have been somewhat disappointing 27.…”

Medication adherence in people dually treated for HIV infection and mental health conditions: test of the medications beliefs framework

“…For example, greater depressive symptoms are associated with poorer psychotropic and antiretroviral adherence, with greater adherence to psychotropics predicting better adherence to antiretrovirals (Cruess et al, 2012). Compared to persons with either HIV infection or psychiatric conditions, dually diagnosed individuals are less likely to fill prescriptions for psychotropics and antiretroviral (Lee, Rothbard, Noll, & Blank, 2011). Substance use is one factor that may influence adherence to both classes of medications (Chitsaz et al, 2013).…”

The concomitant use of second-generation antipsychotics and long-term antiretroviral therapy may be associated with increased cardiovascular risk

“…Prevalence of HIV infection among persons with serious mental illness (SMI) is estimated to be between 3% and 23%, or more than 10 fold higher than the 0.4% in the general United States population (Cournos and McKinnon, 1997; Lee et al, 2011; Meyer, 2003). Due to the high SMI prevalence in this population, psychotropic medications are commonly used by HIV-infected patients (Bing et al, 2001; Gaynes et al, 2008; Thompson et al, 2006; Vitiello et al, 2003; Walkup et al, 2004).…”