Is well known some organic diseases produce psychotic symptoms. Association between HIV and presence of psychopathology is highly prevalent. For this reason, a case report of HIV, liver cirrhosis, drug abuse and psychotic disorder is presented below.

The patient was a 46 year old male infected by HIV and liver cirrhosis (Child-Pugh B) secondary to HCV infection. He had had psychiatric history of major depressive disorder, cannabis use disorder, alcohol use disorder, cocaine use disorder and heroin use disorder. Without consume of heroin, cocaine and alcohol during last 5 years. He was in treatment with methadone, benzodiazepines and antiretroviral treatment.

In 2013 the patient suffered a psychotic episode with an important affective and behavioral repercussion and he was admitted in an acute unit of psychiatry.

It was necessary a pharmacological treatment with a limited hepatic metabolism because of his liver cirrhosis and potential drug interactions with antiretroviral treatment and methadone. So that, it was decided to use oral Paliperidone (9 mg/day), achieving a remission of psychotic symptomatology.

In this case Paliperidone was safe, without side effects and good tolerance. Liver function was preserved and CD4 levels remained undetectable.

In patients with severe mental illness and concomitant organic disease, complexity of treatment is a determining factor in therapeutic decisions.

In conclusion, Paliperidone could be considered sure to treat psychotic symptoms in schizophrenic patients who use others medications with hepatic metabolism, drug interactions, and mild to moderate liver failure.