Schizophrenia might appear to be an obstacle to the initiation of and especially compliance with antiretroviral
therapy for HIV-infected patients. The aims of this study were to describe the clinical, immunologic and virologic course after initiation of antiretroviral
therapy in 7 HIV patients with
schizophrenia (according to DSM-IV-R criteria), and to analyse the possibilities of an adequate antiretroviral
therapy for those patients.
OBSERVATIONS: Multidisciplinary management by specialists in
infectious diseases, addiction-related disorders, treatment adherence and compliance, and psychiatrists, as well as social workers, home care agencies, and patient advocacy and assistance groups, was organized with coordinated medical-psychiatric follow-up at least once a month. The patients, 6 men and 1 woman, were aged from 26 to 48 years;
schizophrenia had been diagnosed in 5 patients 6 months to 20 years before the
HIV infection was discovered; diagnoses of both diseases were essentially simultaneous for the other 2. All patients took long-term
neuroleptics for their
schizophrenia. Two were active drug addicts who received
drug substitution treatment. Before antiretroviral treatment began, 6 patients had advanced
infection: stage C with peak CD4 cell counts ranging from 6 to 70/mm3; they began treatment with
protease inhibitors between May 1996 and August 1997. The seventh patient was first seen during primary
HIV infection in July 1998, and treatment began then. Response to antiretroviral treatment with
protease inhibitors was slow for all patients, but viral load became undetectable for 6 of the 7, after 5 months to 4 years; 3 had
opportunistic infections. Follow-up ended in January 2002: 5 patients still had undetectable viral loads,, with CD4 cell counts ranging from 45 to 1 000/mm3. One patient died from mixed terminal
cirrhosis (
alcohol abuse and
hepatitis C); the viral load in another was only partially controlled (10 000 copies/ml), because of poor treatment adherence.
CONCLUSION: