Psychotropic prescribing in HIV

J Joska,E Reid,C Orrell,K Stoloff

doi:10.7196/sajhivmed.863

Abstract

Psychiatric disorders frequently co-occur with HIV, as preceding conditions or consequent to HIV infection. This potentially compromises HIV diagnosis and antiretroviral (ARV) treatment adherence. We provide a brief guide to the diagnosis and treatment of common mental disorders in people living with HIV/AIDS, including: prescribing psychotropics in HIV; neuropsychiatric side-effects of ARVs and other medications commonly prescribed in HIV; and the diagnosis and treatment of depression, anxiety, psychosis, agitation, sleep disturbance, pain, and mania. Psychotropic treatments recommended were drawn primarily from those available in the public sector of South Africa.

Highlights

Psychiatric disorders frequently cooccur with HIV infection, as conditions preceding or consequent to infection
This article is intended to guide the diagnosis and psychotropic treatment of common mental disorders in people living with HIV/AIDS (PLWHA)
Many psychotropics are taken for ≥6 months, and both psychotropics and antiretrovirals (ARVs) are metabolised by the cytochrome P450 enzyme system, necessitating consideration of pharmacokinetic interactions

Summary

Psychotropic prescribing in HIV

Psychiatric disorders frequently co-occur with HIV, as preceding conditions or consequent to HIV infection This potentially compromises HIV diagnosis and antiretroviral (ARV) treatment adherence. Healthcare providers need to avoid prescribing complex regimens (e.g. daily dose instead of twice daily, where possible), anticipate drug interactions, and consider possible mood, behavioural and cognitive effects of medications such as ARVs. The fact that treating HIV infection and related conditions is essential for optimal psychiatric care is often underappreciated. In mild-moderate depression, patients usually experience transient or mild symptoms occasionally, have low levels of distress, and do not have suicidal thoughts or plans Such symptoms can often be in relation to a recent diagnosis or the commencement of ARV treatment. In cases of severe depression, patients often have persistent, severe symptoms, high levels of distress and

Metronidazole Amphotericin B

As for fluoxetine

Have flumazenil to hand in case of respiratory depression

Sleep disturbance

Conclusion