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HIV-infected patients with severe depression or bipolar disorder often do not adhere to their medication regimens

Inconsistent use of highly active antiretroviral therapy (HAART) regimens among people with HIV increases HIV drug resistance and treatment failure. It also increases the risk of producing drug-resistant strains of the virus that can be transmitted into the general population by risky behavior. Thus, doctors need to know which patients are less likely to stick with the HAART regimen.

A recent study supported in part by the Agency for Healthcare Research and Quality (HS11825) found that patients with severe affective disorder (recurrent major depressive disorder or bipolar disorder)—but not those with schizophrenia—are significantly less persistent in their use of HAART than those without serious mental illness. Patients with schizophrenia are as persistent in adhering to their medication regimen as those without serious mental illness.

Stephen Crystal, Ph.D., and colleagues at Rutgers University compared rates of use of HAART (protease inhibitors, PIs, and non-nucleoside reverse transcriptase inhibitors, NNRTIs) among New Jersey Medicaid beneficiaries with AIDS and with and without serious mental illness between 1996 (when these treatments were introduced) and 1998. Doctors did not appear reluctant to prescribe HAART to patients with serious mental illness. In this sample, patients with schizophrenia (68 percent) and those with severe affective disorder (76 percent) were more likely to have begun HAART than those without serious mental illness (64 percent).

After controlling for demographics, risk group, opportunistic infection, and viral status, PI/NNRTI use was 27 percent less likely for those with severe affective disorders than for those with no serious mental illness. This should not rule out initiation of HAART, notes Dr. Crystal, since numerous opportunities for aggressive treatment of depression have been identified, and treatment of comorbid depression has been found to improve medication adherence with other disorders. Furthermore, HAART regimens themselves can reduce depression. Finally, the findings provide optimism regarding medication adherence among often hard-to-treat schizophrenics.

See "Use of newer antiretroviral treatments among HIV-infected Medicaid beneficiaries with serious mental illness," by James T. Walkup, Ph.D., Usha Sambamoorthi, Ph.D., and Dr. Crystal, in the September 2004 Journal of Clinical Psychiatry 65(9), pp. 1180-1189.

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