College of Psychiatric and Neurologic Pharmacists

Over 1 million people are living with HIV in the United States. Transmission is on the rise in women, Blacks, Hispanics, heterosexuals, adolescents and elderly. People with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome have high rates of psychiatric illness. The effective management of these psychiatric conditions can improve a patient's quality of life and may improve antiretroviral adherence.

This session will outline the pathophysiology of HIV and how it relates to the development of psychiatric illnesses, and how psychiatric illness can lead to transmission of HIV. It will review the 3 major treatment challenges involved in HIV patients with psychiatric comorbidities;  1) Correct psychiatric diagnosis, 2) medication treatment, adherence and side effects, and 3) psychotropic and antiretroviral drug interactions.

The most common drug-drug interactions (DDI’s) with antiretrovirals and psychotropics will be described including the many potential interactions based on cytochrome P450 metabolism, which is common to many psychotropics, the protease inhibitors, and the nonnucleoside reverse-transcriptase inhibitors. Case presentations are used to identify the most appropriate treatment and management of DDI’s in HIV patients with psychiatric illnesses. In managing drug interactions, in general the newer psychotropic agents have a lower potential for drug-drug interactions.For psychotropic dosing in HIV patients, low initial doses and slow titration is necessary to prevent adverse effects.As pharmacists, it is important to keep updated on newly approved medications and their interactions. In conclusion, managing psychiatric illness in HIV-infected patients can be a major challenge and is a perfect role for Psychiatric and Neurologic Pharmacists.

1. Outline pathophysiology of HIV and how it relates to the development of psychiatric illnesses (e.g., depression, psychosis).
2. Indicate the treatment challenges involved in HIV patients with psychiatric comorbidities.
3. Identify the most common drug-drug interactions (DDIs) with antiretrovirals and psychotropics.
4. Identify most appropriate treatment and management of DDIs in HIV patients with psychiatric illnesses.

Activity Dates: 04/20/2010 - 04/20/2013
ACPE Contact Hours: 1.0
ACPE Number: 0284-0000-10-013-H02-P (Knowledge)
Nursing Credit Reminder: Note that ACPE and ACCME credit is accepted for certification renewal.

This course is provided online at cpnp.org and consists of the speaker audio and slides. A PDF file of the slides is also provided and access is available to participants indefinitely although ACPE credit is available only through the course expiration date.

Participants in this course must complete an examination and achieve a score of 60% or greater. Successful completion of the course also requires the completion of a course evaluation. ACPE statements of credit can be retrieved by participants online at cpnp.org immediately upon successful completion of the course.

If you are a pharmacist, nurse practitioner or other healthcare professional involved in the medication therapy management of psychiatric and/or neurological patients, we invite you to participate in this online course.

This programming was supported in part by grants from Bristol-Myers Squibb, Otsuka America Pharmaceutical, Inc., Lilly USA, LLC, AstraZeneca and Cyberonics.