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Background:  Psychiatric disorder is known to be a bad prognostic factor for patients with various medical conditions. Additionally, it is a common co-morbidity in HIV⁺ patients. In this study we compared the prognosis of HIV infection, in the HAART era, between patients with various psychiatric disorders (NPI) and patients without NPI.

Methods:  Retrospective, case control study, comparing 72 HIV⁺ patients with documented psychiatric disease with 76 HIV⁺ patients without diagnosed psychiatric disorder.

Results:  Among the patients with psychiatric disorders there were 17 (10.6%) with psychotic disorder (PSD), 22 (13.75%) with severe personality disorder (PED), and 33 (22.5%) with substance abuse disorders (SAD). There were no significant differences in male/female ratio, age, and race between patients. However, there was a statistically significant difference in the CD4 count when HIV seropositivity was diagnosed:  Rate of PSD with CD4 ≥ 200 was significantly less than in PED, SAD, and NPI (50%, 77%, 100%, and 72.5%, respectively). Median CD4 count while detection was 267, 319, 460, and 330 in PSD, PED, SAD, and NPI, respectively. Five years after detection, median CD4 count was significantly higher in NPI and SAD compared with PSD and PED (563, 533, 234, and 349, respectively), and the rate of patients with undetectable viral load under HAART was 11.7%, 28.5%, 36%, and 68% among PSD, PED, SAD, and NPI, respectively (p < 0.01 for NPI vs other groups). Rate of patients with AIDS or AIDS-related death was 47%, 41%, 0%, and 7.8% among PSD, PED, SAD, and NPI, respectively (p < 0.01).

Conclusions:  Psychiatric patients (psychotics and borderline personalities) infected with HIV are being detected late and have a poorer prognosis compared with HIV⁺ patients with no psychiatric disorders. Communication between the HIV physician and the psychiatric should be encouraged in order to improve patients’ adherence to therapy.

Keywords: Psychiatric; prognosis; adherence