Use of HIV and Psychotropic Medications among Persons with Serious Mental Illness and HIV/AIDS

  • Sungeun Lee
  • Aileen B. Rothbard
  • Elizabeth Noll
  • Michael B. Blank
Original Paper


Persons with serious mental illness (SMI) have higher rates of co-morbid HIV disorders compared to the general population. There are concerns that the SMI/HIV population may be receiving fewer HIV and psychotropic medications due to problems of access and concerns by providers associated with following complex medication regimes. The purpose of this study was to examine any disparity in medication treatment of the SMI/HIV population by comparing medication use and continuity of prescription fills to groups that had HIV or SMI only versus those with SMI/HIV. Study participants were adult Medicaid recipients aged 19–64 with serious mental illness and HIV receiving services in Philadelphia from 2002 through 2003. Differences between the groups in case mix characteristics, medication use rates, and continuity of psychotropic and antiretroviral medication use were compared using Chi-square, t-tests of significance, and logistic regression. Co-morbid individuals were as likely to have filled prescriptions for psychotropic and antiretroviral medications as those with a single disorder and equally persistent in their continuity of antiretroviral medication refills as those with HIV only. However, persons with co-morbid condition had lower continuity of psychotropic medication use compared to those with SMI only. Our findings suggest the need to develop an integrated medical and behavioral healthcare model to improving coordination and treatment for patients with co-occurring disorders. Future research is warranted to investigate the reasons for the discrepancy in continuity of psychotropic adherence for the SMI/HIV population.


HIV/AIDS Co-morbid Seriously mentally ill Pharmacological utilization Treatment disparity 


  1. Ashman, J. J., Conviser, R., & Pounds, M. B. (2002). Associations between HIV-positive individuals’ receipt of ancillary services and medical care receipt and retention. AIDS Care, 14(Suppl 1), 109–118.CrossRefGoogle Scholar
  2. Bagchi, A., Sambamoorthi, U., McSpiritt, E., et al. (2004). Use of antipsychotic medications among HIV-infected individuals with schizophrenia. Schizophrenia Research, 71, 435–444.PubMedCrossRefGoogle Scholar
  3. Bartels, S. J. (2004). Caring for the whole person: Integrated health care for older adults with severe mental illness and medical comorbidity. Journal of the American Geriatrics Society, 52(12 Suppl), S249–S257.PubMedCrossRefGoogle Scholar
  4. Bassetti, S., Battegay, M., Furrer, H., et al. (1999). Why is highly active antiretroviral therapy (HAART) not prescribed or discontinued? Swiss HIV cohort study. Journal of Acquired Immune Deficiency Syndromes, 21, 114–119.PubMedGoogle Scholar
  5. Blank, M. B., Mandell, D. S., Aiken, L., et al. (2002). Co-occurrence of HIV and serious mental illness among Medicaid recipients. Psychiatric Services, 53, 868–873.PubMedCrossRefGoogle Scholar
  6. Bogart, L. M., Kelly, J. A., Catz, S. L., et al. (2000). Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment. Journal of Acquired Immune Deficiency Syndromes, 23, 396–404.PubMedCrossRefGoogle Scholar
  7. Brown, S. (1997). Excess mortality of schizophrenia: A meta-analysis. British Journal of Psychiatry, 171, 502–508.PubMedCrossRefGoogle Scholar
  8. Brunette, M. F., Mercer, C. C., Carlson, C. L., et al. (2000). HIV-related services for persons with severe mental illness: Policy and practice in New Hampshire community mental health. Journal of Behavioral Health Services and Research, 27, 347–353.PubMedCrossRefGoogle Scholar
  9. Carey, M. P., Carey, K. B., & Kalichman, S. C. (1997). Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illness. Clinical Psychology Review, 17, 271–291.PubMedCrossRefGoogle Scholar
  10. Centers for Disease Control and Prevention. (2004). HIV/AIDS surveillance report 2003 (Vol. 15, pp. 1–46). Atlanta, GA: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention.
  11. Chwastiak, L., Rosenheck, R., & Douglas, L. (2006). Impact of medical comorbidity on the quality of schizophrenia pharmacotherapy in a National VA sample. Medical Care, 44, 55–61.PubMedCrossRefGoogle Scholar
  12. Corrigan, P. W. (2002). Adherence to anti-psychotic medications and health behavior theories. Journal of Mental Health, 11, 243–254.CrossRefGoogle Scholar
  13. Cournos, F., & McKinnon, K. (1997). HIV seroprevalence among people with severe mental illness in the United States: A critical review. Clinical Psychology Review, 17, 159–169.CrossRefGoogle Scholar
  14. Crystal, S., Akincigil, A., Bilder, S., et al. (2007). Studying prescription drug use and outcomes with Medicaid claims data. Medical Care, 45(Suppl), S58–S65.PubMedCrossRefGoogle Scholar
  15. Crystal, S., Sambamoorthi, U., & Merzel, C. (1995). The diffusion of innovation in AIDS treatment: Zidovudine use in two New Jersey cohorts. Health Services Research, 30, 591–612.Google Scholar
  16. Crystal, S., Sambamoorthi, U., Moynihan, P. J., et al. (2001). Initiation and continuation of newer antiretroviral treatments among Medicaid recipients with AIDS. Journal of General Internal Medicine, 16, 850–859.PubMedCrossRefGoogle Scholar
  17. Davidson, M. (2002). Risk of cardiovascular disease and sudden death in schizophrenia. Journal of Clinical Psychiatry, 63, 5–11.PubMedGoogle Scholar
  18. Dembling, B. P., Chen, D. T., & Vachon, L. (1999). Life expectancy and causes of death in a population treated for serious mental illness. Psychiatric Services, 50, 1036–1042.PubMedGoogle Scholar
  19. Drake, R. E., Mercer-McFadden, C., Mueser, K. T., et al. (1998). Review of integrated mental health substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24, 589–608.PubMedGoogle Scholar
  20. Druss, B. G., Rosenheck, R. A., Desai, M. M., et al. (2002). Quality of preventive medical care for patients with mental disorders. Medical Care, 40, 129–136.PubMedCrossRefGoogle Scholar
  21. Enger, C., Weatherby, L., Reynolds, R. F., et al. (2004). Serious cardiovascular events and mortality among patients with schizophrenia. Journal of Nervous and Mental Disease, 192, 19–27.PubMedCrossRefGoogle Scholar
  22. Essock, S. M., Dowden, S., Constantine, N. T., et al. (2003). Blood-borne infections and persons with mental illness: Risk factors for HIV, hepatitis B, and hepatitis C among persons with severe mental illness. Psychiatric Services, 54, 836–841.PubMedCrossRefGoogle Scholar
  23. Felker, B., Yazel, J. J., & Short, D. (1996). Mortality and medical comorbidity among psychiatric patients: A review. Psychiatric Services, 47, 1356–1363.PubMedGoogle Scholar
  24. Frayne, S. M., Halanych, J. H., Miller, D. R., et al. (2005). Disparities in diabetes care: Impact of mental illness. Archives Internal Medicine, 165(22), 2631–2638.CrossRefGoogle Scholar
  25. Fremont, A. M., Young, A. S., Chinman, M., et al. (2007). Differences in HIV care between patients with and without severe mental illness. Psychiatric Services, 58, 681–688.PubMedCrossRefGoogle Scholar
  26. Goff, D. C., Sullivan, L. M., McEvoy, J. P., et al. (2005). A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophrenia Research, 80, 45–53.PubMedCrossRefGoogle Scholar
  27. Goldman, L. S. (2000). Comorbid medical illness in psychiatric patients. Current Psychiatry Reports, 2, 256–263.PubMedCrossRefGoogle Scholar
  28. Gottesman, I. I., & Groome, C. S. (1997). HIV/AIDS risks as a consequence of schizophrenia. Schizophrenia Bulletin, 23, 675–684.PubMedGoogle Scholar
  29. Hogg, R. S., Heath, K. V., Yip, B., et al. (1998). Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA, 279, 450–454.PubMedCrossRefGoogle Scholar
  30. Jamieson, D. J., Duerr, A., Robert, K. S., et al. (2001). Longitudinal analysis of bacterial vaginosis: Findings from the HIV epidemiology research study. Obstetrics and Gynecology, 98, 656–663.PubMedCrossRefGoogle Scholar
  31. Kaiser Family Foundation. (2009). HIV/AIDS policy fact sheet, medicaid and HIV/AIDS, February 2009. U.S. Federal Funding for HIV/AIDS.Google Scholar
  32. Kilbourne, A. M., Brar, J. S., Drayer, R. A., et al. (2007). Cardiovascular disease and metabolic risk factors in male patients with schizophrenia, schizoaffective disorder, and bipolar disorder. Psychosomatics, 48, 412–417.PubMedCrossRefGoogle Scholar
  33. Kleeberger, C. A., Phair, J. P., Strathdee, S. A., et al. (2001). Determinants of heterogeneous adherence to HIV-antiretroviral therapies in the multicenter AIDS cohort study. Journal of Acquired Immune Deficiency Syndromes, 26, 82–92.PubMedCrossRefGoogle Scholar
  34. Laine, C., Newschaffer, C. J., Zhang, D., et al. (2000). Adherence to antiretroviral therapy by pregnant women infected with human immunodeficiency virus: A pharmacy claims-based analysis. Obstetrics and Gynecology, 95, 167–173.PubMedCrossRefGoogle Scholar
  35. Lurie, N., Popkin, M., Dysken, M., et al. (1992). Accuracy of diagnoses of schizophrenia in Medicaid claims. Hospital & Community Psychiatry, 43, 69–71.Google Scholar
  36. Massad, P. M., West, A. N., & Friedman, M. J. (1990). Relationship between utilization of mental health and medical services in a VA hospital. American Journal of Psychiatry, 147, 465–469.PubMedGoogle Scholar
  37. McKinnon, K., & Cournos, F. (1998). HIV infection linked to substance use among hospitalized patients with severe mental illness. Psychiatric Services, 49, 1269.PubMedGoogle Scholar
  38. McQuillan, G. M., Khare, M., Karon, J. M., et al. (1997). Update on the seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988–1994. Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology, 4, 355–357.CrossRefGoogle Scholar
  39. Mellins, C. A., Havens, J. F., McDonnell, C., et al. (2009). Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders. AIDS Care, 21, 168–177.PubMedCrossRefGoogle Scholar
  40. Minkoff, K. (1994). Models for addiction treatment in psychiatric populations. Psychiatric Annals, 24, 412–417.Google Scholar
  41. Mitchell, A. J., Malone, D., & Doebbeling, C. C. (2009). Quality of medical care for people with and without comorbid mental illness and substance misuse: Systematic review of comparative studies. The British Journal of Psychiatry, 194, 491–499.PubMedCrossRefGoogle Scholar
  42. Nasrallah, H. A., Meyer, J. M., Goff, D. C., et al. (2006). Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: Data from the CATIE schizophrenia trial sample at baseline. Schizophrenia Research, 86, 15–22.PubMedCrossRefGoogle Scholar
  43. Olfson, M., Marcus, S., Weissman, M. M., et al. (2002). National trends in the use of psychotropic medications by children. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 514–521.CrossRefGoogle Scholar
  44. Osborn, D. P., Nazareth, I., & King, M. B. (2006). Risk for coronary heart disease in people with severe mental illness: Cross-sectional comparative study in primary care. British Journal of Psychiatry, 188, 271–277.PubMedCrossRefGoogle Scholar
  45. Palmer, N. B., Basinski, J. R., & Uldall, K. K. (2010). Psychiatric illness, access and adherence to HAART: A brief review of recent findings and implications for care. HIV Therapy, 4, 215–230.CrossRefGoogle Scholar
  46. Parry, C. D., Blank, M. B., & Pithey, A. L. (2007). Responding to the threat of HIV among persons with mental illness and substance abuse. Current Opinion in Psychiatry, 20, 235–241.PubMedGoogle Scholar
  47. Perkins, D. O. (1999). Adherence to psychotropic medications. Journal of Clinical Psychiatry, 60(Suppl 21), 25–30.PubMedGoogle Scholar
  48. Roberts, R. R., Kampe, L. M., Hammerman, M., et al. (2006). The cost of care for patients with HIV from the provider economic perspective. AIDS Patient Care and STDs, 20, 876–885.PubMedCrossRefGoogle Scholar
  49. Rosenberg, S. D., Goodman, L. A., Osher, F. C., et al. (2001). Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness. American Journal of Public Health, 91, 31–37.PubMedCrossRefGoogle Scholar
  50. Rosenberg, S. D., Swanson, J. W., Wolford, G. L., et al. (2003). Blood-borne infections and persons with mental illness: The five-site health and risk study of blood-borne infections among persons with severe mental illness. Psychiatric Services, 54, 827–835.PubMedCrossRefGoogle Scholar
  51. Rothbard, A. B., Lee, S., & Blank, M. B. (2009a). Cost of treating seriously mentally ill persons with HI following HAART. Journal of Mental Health Policy and Economics, 12, 187–194.PubMedGoogle Scholar
  52. Rothbard, A. B., Metraux, S., & Blank, M. B. (2003). Cost of care for Medicaid recipients with serious mental illness and HIV infection or AIDS. Psychiatric Services, 54, 1240–1246.PubMedCrossRefGoogle Scholar
  53. Rothbard, A. B., Miller, K., Lee, S., et al. (2009b). Revised cost estimates of medicaid recipients with serious mental illness and HIV-AIDS. Psychiatric Services, 60, 974–977.PubMedCrossRefGoogle Scholar
  54. Salsberry, P. J., Chipps, E., & Kennedy, C. (2005). Use of general medical services among Medicaid patients with severe and persistent mental illness. Psychiatric Services, 56, 458–462.PubMedCrossRefGoogle Scholar
  55. Seeman, M., Lang, M., & Rector, N. (1990). Chronic schizophrenia: A risk factor for HIV? Canadian Journal of Psychiatry, 35, 765–768.Google Scholar
  56. Sokal, J., Messias, E., Dickerson, F. B., et al. (2004). Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. Journal of Nervous and Mental Disease, 192, 421–427.PubMedCrossRefGoogle Scholar
  57. Solomon, P. L., Tennile, J. A., Lipsott, D., et al. (2007). Rapid assessment of existing HIV prevention programming in a community mental health centre. Journal of Prevention & Intervention in the Community, 33, 137–150.CrossRefGoogle Scholar
  58. Soto, T. A., Bell, J., & Pillen, M. B. (2004). Literature on integrated HIV care: A review. AIDS Care, 16(Suppl), 43–55.CrossRefGoogle Scholar
  59. Sullivan, G., Koegel, P., Kanouse, D. E., et al. (1999). HIV and people with serious mental illness: The public sector’s role in reducing HIV risk and improving care. Psychiatric Services, 50, 648–652.PubMedGoogle Scholar
  60. Thompson, A., Silverman, B., Dzeng, L., et al. (2006). Psychotropic medications and HIV. Clinical Infectious Diseases, 42, 1305–1310.PubMedCrossRefGoogle Scholar
  61. Treisman, G. J., Angelino, A. F., & Hutton, H. E. (2001). Psychiatric issues in the management of patients with HIV infection. JAMA, 12, 2857–2864.CrossRefGoogle Scholar
  62. Tucker, J. S., Burnam, M. A., Sherbourne, C. D., et al. (2003). Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. The American Journal of Medicine, 114, 573–580.PubMedCrossRefGoogle Scholar
  63. Turner, B. J., Fleishman, J. A., Wenger, N., et al. (2003). Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons. Journal of General Internal Medicine, 16, 625–633.CrossRefGoogle Scholar
  64. Turner, B. J., Newschaffer, C., Zhang, D., et al. (2000). Antiretroviral use and pharmacy-based measurement of adherence in postpartum HIV-infected women. Medical Care, 38, 911–925.PubMedCrossRefGoogle Scholar
  65. Uldall, K. K., Palmer, N. B., Whetten, K., et al. (2004). Adherence in people living with HIV/AIDS, mental illness, and chemical dependency: A review of the literature. AIDS Care, 16(Suppl 1), 71–96.CrossRefGoogle Scholar
  66. Vitiello, B., Burnam, A., Bing, E. G., et al. (2003). Use of psychotropic medications among HIV-infected patients in the United States. American Journal of Psychiatry, 160, 547–554.PubMedCrossRefGoogle Scholar
  67. Walkup, J., Blank, M. B., Gonzalez, J. S., et al. (2008). The impact of mental health and substance abuse factors on HIV prevention and treatment. Journal of Acquired Immune Deficiency Syndromes, 47(Suppl l), 15–19.Google Scholar
  68. Walkup, J. T., Sambamoorthi, U., & Crystal, S. (2004). Use of newer antiretroviral treatments among HIV-infected Medicaid beneficiaries with serious mental illness. Journal of Clinical Psychiatry, 65, 1180–1189.PubMedCrossRefGoogle Scholar
  69. West, J. C., Wilk, J. E., Rae, D. S., et al. (2009). Medicaid prescription drug policies and medication access and continuity: Findings from ten States. Psychiatric Services, 60, 601–610.PubMedCrossRefGoogle Scholar
  70. Wohler-Torres, B. A., Valverder, E. E., Anderson-Mahoney, P., et al. (2002). System barriers to HIV medical care appointment compliance: Results of the ARTAS study. International conference on AIDS, July 7–12, 14: abstract no. G12519.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Sungeun Lee
    • 1
  • Aileen B. Rothbard
    • 2
  • Elizabeth Noll
    • 2
  • Michael B. Blank
    • 2
    • 3
    • 4
  1. 1.Department of Social WelfarePusan National UniversityBusanSouth Korea
  2. 2.Department of Psychiatry, Center for Mental Health Policy and Services ResearchUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Penn Center for AIDS ResearchUniversity of PennsylvaniaPhiladelphiaUSA

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