HIV and Hepatitis C in Patients With Schizophrenia

Introduction

Among the chronic health conditions experienced by people with schizophrenia, infection with human immunodeficiency virus (HIV) or hepatitis C virus (HCV) occurs with notable frequency. People who contract HIV face chronic illness, the likelihood of premature death, complicated medication regimens, barriers to medical care, and the neuropsychiatric sequelae of HIV infection itself. HCV is emerging as a significant public health issue due to the persistence of viremia in over 75% of infected persons, with resultant cirrhosis in up to 20% after 10 to 30 years and, in rare cases, hepatocellular carcinoma. It is estimated that in the United States less than 30% of people with HCV know they are infected (National Institutes of Health Consensus Development Conference Panel 1997).

Published rates of HIV infection among psychiatric patients are 3.1% to 23.9%, at least eight times higher than estimates for the general population (Cournos and McKinnon 1997; Rosenberg et al. 2001). These seroprevalence studies were all conducted on the East Coast; in other parts of the United States, no published seroprevalence studies exist to shed light on whether people with severe mental illness in those localities are at increased risk of HIV infection. HIV infection rates among patients with schizophrenia rarely have been differentiated from rates among others with psychotic disorders; but when they have, no significant differences emerged, countering expectations that infection rates might be lower among those with schizophrenia than among those with other severe mental illnesses.

Rates of HCV infection among people with schizophrenia have received far less attention. A large retrospective Italian study found that 6.7% of 1,180 patients hospitalized for mental retardation, psychosis, and dementia were infected with HCV (Cividini et al. 1997). Psychosis and a history of trauma were statistically significant independent risk factors associated with HCV infection (Cividini et al. 1997).

In the United States, the magnitude of the threat has been quantified in one published study that found a prevalence of 19.6% among 751 psychiatric inpatients and outpatients tested in a multisite study on the East Coast (Rosenberg et al. 2001). On the West Coast, preliminary findings among 508 state hospital adult inpatients show that 20.3% were HCV seropositive (Meyer, in press). These rates contrast with the general population rate of approximately 1.8%.

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Psychiatric symptoms and disabilities differentiate this population from others and may increase HIV/HCV risk among people with the most serious psychiatric disorders, either by directly affecting behavior or by interfering with the ability to acquire or use information about these illnesses to practice safer behaviors. Wherever they work, psychiatrists and other mental health care providers often are in the best position to enhance their patients' skills in modifying high-risk behaviors and to connect infected psychiatric patients with the HIV- and HCV-related services they need.