Schizophrenia and HIV

There is very little published information regarding the co-occurrence of human immunodeficiency virus (HIV)-spectrum illness and psychotic illnesses, including schizophrenia, even though their coexistence in the same patient may severely affect the course of both illnesses. Estimates of the frequency of HIV infection in patients with preexisting mental illness range between 5 and 7 percent. Estimates of new-onset psychosis in patients with HIV-spectrum illness range between 0.2 and 15 percent and may increase as the stage of HIV illness progresses. Regardless of which illness came first, their occurrence together appears to be associated with more morbidity and mortality than would be expected with either illness alone. Patients with new-onset psychosis respond to and tolerate relatively low doses of antipsychotic medication. Whether the presence of HIV decreases the effective daily dose of neuroleptic medication in patients with preexisting psychosis is not yet known. A clearly superior neuroleptic medication for patients with both psychosis and HIV infection has not yet been identified. Further systematic exploration is needed.