01 - Prescribing in human immunodeficiency virus (

Prescribing in human immunodeficiency virus (HIV)

The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. David M. Taylor, Thomas R. E. Barnes and Allan H. Young. © 2025 David M. Taylor. Published 2025 by John Wiley & Sons Ltd. Chapter 10 Prescribing in human immunodeficiency virus (HIV) People living with human immunodeficiency virus (PLWH) may experience symptoms of mental illness because of a variety of factors (Box 10.1). In practice, several of these factors may coexist within an individual.1 When prescribing psychotropics, the following principles should be adhered to: ■ ■Start with a low dose and titrate according to tolerability and response. ■ ■Select the simplest dosing regimen possible. (Remember that the patient’s drug ­regimen is likely to be complex already.) ■ ■Select an agent with the fewest adverse effects. Consider drug interactions, medical comorbidities and any ongoing substance misuse. ■ ■Ensure that management is conducted in close co-­operation with the HIV specialists and the rest of the multidisciplinary team. Drug treatment of psychiatric symptoms occurring in the context of other conditions Box 10.1  Factors contributing to the development of psychiatric symptoms in people living with HIV ■ ■Primary (or pre-­existing) psychiatric disorders ■ ■Neurobiological changes caused by HIV in the CNS ■ ■Other infections or CNS tumours ■ ■Antiretroviral drugs and other medical treatments ■ ■Alcohol or substance misuse (particularly crystal methamfetamine and GHB/GBL) ■ ■Adverse psychosocial factors (e.g. stigma, social isolation) ■ ■Awareness of a chronic disease requiring strict adherence to medication CNS, central nervous system; GHB/GBL, gamma hydroxybutyrate/gamma butyrolactone.