Clozapine Use in HIV-Infected Schizophrenia Patients: A Case-Based Discussion and Review

Background: Schizophrenia is a common neuropsychiatric disorder that is associated with an increased risk for HIV infection. Because schizophrenia may affect the ability of HIV-infected patients to adhere to their antiretroviral regimen, optimal management of their mental illness is a high priority in such individuals. However, 20% to 30% of patients with schizophrenia are refractory to first-line antipsychotics. Objective: Given the frequency of comorbid HIV infection and schizophrenia, the authors investigated the potential role of clozapine, with the idea that this medication may be considered for use in this particular patient population. Method: The authors present histories of clozapine treatment in two patients with schizophrenia and comorbid HIV illness. The use of clozapine in this population, along with potential pharmacodynamic and pharmacokinetic drug interactions are discussed. Results: Management and information regarding the use of clozapine in patients with schizophrenia and comorbid HIV illness are presented. Discussion: Clozapine can be used successfully in HIV-infected individuals, with control of viral replication an achievable goal, particularly for those patients in whom there is some external oversight of medication adherence. A multidisciplinary approach must be adopted, with the consultation psychiatrist providing the best possible control of psychiatric problems so that infectious-disease doctors can achieve the goal of HIV replication control. (Psychosomatics 2009; 50: 626-632)