  
Schizophrenic HIV patients comply with antiretroviral therapy
Last Updated: 2001-04-23 13:45:54 EDT (Reuters Health)
By Will Boggs, MD
WESTPORT, CT (Reuters Health) - HIV-infected individuals with schizophrenia comply with antiretroviral drug therapies at least as well as HIV-positive individuals without schizophrenia do, according to a report in the March issue of the Journal of Clinical Psychiatry.
Schizophrenia has been associated with poor drug compliance in other conditions, the authors explain, but the consistency of antiretroviral drug use among schizophrenic patients has not been examined previously.
Dr. James Walkup and colleagues, from Rutgers University, in New Brunswick, New Jersey, used three databases to estimate antiretroviral therapy adherence among adult Medicaid recipients--6757 without a diagnosis of schizophrenia or affective psychoses and 987 with such diagnoses.
"Contrary to the stereotype of the noncompliant psychiatric patient," the researchers write, "we found that patients with schizophrenia used antiretroviral drugs more consistently than other patients." Perhaps, the authors suggest, the greater involvement of psychiatric patients with healthcare providers accounts for their greater compliance.
The investigators caution that their results rely on data on filled prescriptions rather than measures of actual antiretroviral drug use. With that caveat, they conclude, "Results do not indicate that HIV-seropositive patients with schizophrenia are less adherent to HIV therapies than HIV-positive patients without schizophrenia."
"Internists, infectious disease physicians and others treating HIV in patients with serious mental illness must make an individualized assessment of a patient's capacity to adhere," Dr. Walkup told Reuters Health. "It is demonstrably a big mistake to just assume these patients won't or can't adhere, despite the reputation they enjoy in general medicine."
"Moreover," Dr. Walkup said, "going beyond the data to draw on clinical experience, physicians ought not to consider a patient's capacity to adhere as something fixed and timeless. It can often be affected by aggressive efforts to support adherence."
J Clin Psychiatry 2001;62:174-178.
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