title: Schizophrenia, AIDS and the decision to prescribe HAART: results of a national survey of HIV clinicians.
abstract: Individuals with schizophrenia are at risk of developing HIV and are known to experience barriers to optimal medical care. Our goal was to determine, among a cohort of HIV clinicians, whether or not the diagnosis of schizophrenia affected the clinical decision to offer highly active antiretroviral therapy (HAART) to AIDS patients. This is a cross-sectional study of a random, national sample of HIV experts drawn from the membership of the American Academy of HIV Medicine. Participants were mailed a self-administered questionnaire with a case vignette of a new onset AIDS patient and were specifically asked whether or not they would recommend HAART treatment. Vignettes were randomly assigned to include a diagnosis of schizophrenia or not. We located 649 clinicians (93%); 347 responded (53.4%). Responders and non-responders did not differ in demographics or work characteristics. Recommendation of antiretroviral treatment did not differ between those who received a case vignette with schizophrenia versus those who did not(95.8% vs. 96.6%, p=0.69). Compared to those who received a case vignette without schizophrenia, those who received vignettes with schizophrenia were more likely to avoid prescribing efavirenz, a medication with known neuropsychiatric side effects(17.7% vs. 45.5%, p < 0.01), more likely to agree to be helped by a specialist(34.5% vs. 12.9%, p < 0.01), and more likely to recommend directly observed therapy (20% vs.10%, p = 0.01). HIV clinicians recognize the importance of recommending HAART treatment to individuals with schizophrenia and AIDS and avoid using antiretroviral medication with known neuropsychiatric side effects.
authors.affiliation: Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, 685 West Baltimore St, MSTF Bldg, Suite 300, Baltimore, MD, 21201-1549, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Himelhoch
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: William
authors.initials: W
authors.lastname: Breakey
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000523:psychology; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003657:Decision Making; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications*; D011795:Surveys and Questionnaires; D014481:United States