Use of Newer Antiretroviral Treatments Among HIV-Infected Medicaid Beneficiaries With Serious Mental Illness

James T. Walkup, Ph.D.; Usha Sambamoorthi, Ph.D.; and Stephen Crystal, Ph.D.

Objectives: The study compares rates of protease inhibitor (PI) use during the 3 years following the introduction of these newer treatments among human immunodeficiency virus (HIV)-infected individuals with and without serious mental illness and examines persistence of use of these therapies across these subgroups.

Method: We used merged autoimmune deficiency syndrome (AIDS)/HIV surveillance and Medicaid claims data to examine use of PIs and non-nucleoside reverse transcriptase inhibitors (NNRTIs) among New Jersey Medicaid beneficiaries with AIDS between 1996 and 1998. Based on the ICD-9-CM diagnoses assigned by a high-credibility source in 1 inpatient or 2 outpatient claims, we identified patients with schizophrenia (ICD-9-CM code 295) and those with severe affective disorder (combining patients with recurrent major depressive disorder [ICD-9-CM code 296.3] or bipolar disorder [296.4, 296.5, 296.6, 296.7, or 296.8]). These groups were compared with those patients with no serious mental illness.

Results: In this sample, patients with schizophrenia (68.3%) and those with severe affective disorder (75.6%) were more likely to have initiated new antiretroviral therapy than were those without serious mental illness (64.3%). Patients with severe affective disorder, but not those with schizophrenia, were significantly less persistent (p < .01) in their use of PI/NNRTI therapy than those without serious mental illness.

Conclusions: No evidence was found that the presence of a serious mental illness discourages physicians from initiating new antiretroviral therapy, perhaps reflecting a comparatively high level of integration of these patients into the health care system. Patients with schizophrenia are as persistent in their use of PI/NNRTI therapy as those without a serious mental illness. Lower rates of medication compliance by those with severe affective disorder justify increased efforts to support optimal adherence.

(J Clin Psychiatry 2004;65:1180-1189)

Received Nov. 21, 2002; accepted Jan. 29, 2004. From the Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, N.J.

The findings and opinions reported here are those of the authors and do not necessarily represent the views of any other individuals or organizations.

Supported by grant RO1 MH58984 from the National Institute of Mental Health, Major Mental Disorders and HIV-Health Services Use; grant RO1 DA 11362 from the National Institute on Drug Abuse; State/Territorial Minority HIV/AIDS Demonstration grant D92MP99003-01 (Dr. Walkup); and grant R24HS11825 from the Agency for Healthcare Research and Quality (Dr. Crystal, Rutgers Center for Health Services Research Development).

Acknowledgments appear at the end of this article.

Corresponding author and reprints: James T. Walkup, Ph.D., Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 30 College Avenue, New Brunswick, NJ 08901(e-mail: walkup@rci.rutgers.edu).