How does HIV status affect rates of psychotropic use by Medicaid patients with schizophrenia?

Objectives: To investigate the impact of co-occurring HIV on psychotropic prescription practices for Medicaid patients diagnosed with schizophrenia (SZ).

Methods: Naturalistic observational study using Medicaid Analytic Extract files for 1999-2000 from California, Florida, New Jersey, and New York. Diagnostic classification based on International Classification of Disease 9 – Clinical Modification. Inclusion criteria: Patients >17 years old with one inpatient or two outpatient claims for SZ (295.x), and a minimum of one full year eligibility. Exclusion criteria: comprehensive HMO coverage or long term care days. Presence of HIV was based on one inpatient or two outpatient claims (042-044). Medication use based on prescription drug claims.

Results: Among patients with SZ rates of use of any antipsychotic medication were substantial for patients with HIV (~70% in both years), but lower than for patients with no HIV (~79% in both years). This pattern of lower rates of use by the group with HIV held both for any use of a typical antipsychotic (36% vs. 44% in 1999, 31% vs. 39% in 2000), and for any use of an atypical antipsychotic (52% vs. 57% in 1999, 59% vs. 63% in 2000).

Discussion Rates of antipsychotic are significant among patient with schizophrenia and HIV, underlining the challenges posed for pharmacological treatment of this high need group. Lower use rates may reflect concern about the impact of HIV or antiretroviral use on antipsychotic response. Research is needed on the needs and clinical outcomes of patients with schizophrenia and HIV not receiving antipsychotic care.