The influence of mental illness on prescribing practices of anti-retrovirals (ART)

Abstract

Evidence has shown that there is an increase in psychiatric co-morbidity amongst HIV-infected patients. However, there is limited data on prescribing of Antiretrovirals in this population, specifically in developing countries and South Africa. Furthermore, there are no guidelines as to which regimen should be prescribed for this group. The aim of this study was therefore to describe the ART regimen of patients attending the HIV Neuropsychiatric Clinic at Chris Hani Baragwanath Hospital and to ascertain if these patients were prescribed in accordance with the South African National Guidelines for Adults. Methods: A retrospective record review was conducted of all new adult patients with both HIV and a mental illness that attended the hospital’s Neuropsychiatric Clinic from 1st April 2010 until 30th August 2012. The demographic information, clinical characteristics and psychotropic medication were examined and the prescribing practices of ART were reviewed to ascertain if these patients were following the National Guidelines for initiation of ART in the general adult population. If prescriptions were shown to deviate, the reasons for this were examined. Results: 197 patient records met the criteria over the study period. 81% of the patients were prescribed the National Guidelines. Those not on these regimens were more likely to be male, have renal dysfunction, anaemia or, importantly, a diagnosis of HIV-associated Neurocognitive Disorder. 77% of patients were started on a regimen containing Efavirenz, even with a concomitant mental illness. Conclusion: In conclusion, the majority of patients with both mental illness and HIV were prescribed the regimens suggested for the general population. However, there was a subset of patients that required more tailored care. This audit can form the basis of future research into the long-term outcomes of patients on regimens that deviate due to a diagnosis of HAND, as well as the use of Efavirenz in this population.