Psychotic Disorders with HIV Infection: A Review

Background: Psychosis and HIV/AIDS are comorbid in some subjects. Their association might be simply coexisting or complex psychosis enhances the risk to contract or protract HIV infection, and HIV/AIDS increases the risk to develop psychosis in terms direct effect of HIV on CNS or prescribed medications. Objective: This review focused on the association of psychosis and HIV/AIDS with conceptual issues in their coexistence and management. Method: A literature review was conducted using PubMed and Google Scholar databases from 1970 to January 2012 to identify studies focused on HIV, AIDS, psychosis, psychiatric disturbances and side effects of antiretroviral therapy and antipsychotics. Results: We review the limited research available on association of HIV and psychosis. Up to one-fourth of the subjects (3%-23%) with psychotic disorders were HIV positive. In contrast, the prevalence of new-onset psychosis among patients with HIV infection ranges 0.23-15.2%. Psychosis is also found to be associated with medical conditions, substance dependence and more importantly with medications used to treat HIV/AIDS, especially efavirenz. Conclusions: A thorough evaluation of HIVAIDS patients with psychotic symptoms requires a comprehensive history and physical examination to rule out other known causes of psychosis. Atypical antipsychotics especially risperidone, followed by clozapine and olanzapine are supported for the treatment of new-onset psychosis in HIV positive subjects (German J Psychiatry 2013; 16(1): 43-48).