Many patients suffer from comorbid HIV and Schizophrenia diagnoses. Patients with schizophrenia and other psychosis are at increased risk of contracting HIV due to numerous psychosocial factors including increased frequency of drug use, increased rates of victimization, and increased propensity for high-risk sexual behaviors. In addition to deficits in functioning related to psychiatric illness, patients with HIV also suffer from virus-related neurocognitive insults. It is quite possible that inflammation associated with an untreated HIV infection could compound the pre-existing neurocognitive decline seen in patients with schizophrenia and other psychosis, creating poor outcomes and treatment-resistant pathology. The benefit of clozapine treatment for schizophrenia patients with comorbid HIV extends beyond just symptomatic control. Long-term and consistent treatment of schizophrenia can be a stepping-stone for the improvement of many psychosocial aspects of life. Patients with well-controlled schizophrenia can lead relatively unaffected lives with improved insight and self-care. Improved insight allows patients to better understand their illness, treatment regimen, and follow-up needs. Improved self-care contributes to increased adherence to treatment regimens and overall health. It is likely that patients who are consistently treated for their schizophrenia will have an increased capacity to understand their HIV diagnosis. With gained understanding, these patients may be more likely to adhere to HAART therapy for HIV and to attend follow-up appointments with infectious disease or primary care. Furthermore, with adherence to HAART therapy, patients can enjoy an improved quality and duration of life by raising CD4 counts and preventing progression to AIDS or succumbing to AIDS-related opportunistic infections.

A patient with schizophrenia and HIV diagnosis was monitored and interviewed with repeated MOCA scoring over a lengthy hospitalization period. During this time, he was titrated to an effective dose of clozapine totaling 400 mg at bedtime. His MOCA scores were compared over this period.

In this case, we have observed that starting a patient on clozapine with therapeutic levels for adequate period has improved MOCA scores. Low MOCA scores could be due to untreated HIV, untreated underlying psychosis. Improved MOCA scores have led the patient to gain insight into his HIV diagnosis. For the first time, he felt the need to be on antiretroviral medication and understood the chronic nature of his illness.

In conclusion, this case describes a patient with untreated HIV and comorbid schizophrenia who is started on clozapine to gain insight into his medical conditions and become more adherent with HIV HAART. The patient shows improvement in PANSS and MOCA scores, supporting an increased awareness of his illness and an increased ability to remain on treatment.

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