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EV0346

HIV-associated psychosis in a patient receiving long-term HIV treatment: a case report and brief literature review

HIV-ASSOCIATED PSYCHOSIS IN A LONG-TERM TREATED HIV PATIENT, A CASE REPORT AND BRIEF LITERATURE REVIEW

HIV-associated psychosis can occur even in patients with an undetectable viral load and full treatment adherence, and requires careful antipsychotic selection.

The aim of this report is to present a case of HIV-associated psychosis in a patient receiving long-term HIV treatment and to review the management of psychotic disorders in people living with HIV (PLWH). The case report is followed by a brief literature review conducted using the PubMed, Scopus, and Web of Science databases. A 40-year-old man who had been receiving treatment for HIV infection for eight years was admitted to an acute psychiatric ward with a first psychotic episode; his presentation included delusions of control and of being monitored, auditory hallucinations, hypochondriacal and persecutory delusions, paranoia, and insomnia, with symptoms persisting for 14 months. The patient had an unremarkable family history, was receiving treatment for dyslipidemia, was fully adherent to HIV treatment and follow-up appointments, and had an undetectable viral load on follow-up laboratory testing; he reported methamphetamine and cannabinoid use approximately twice a year. Diagnostic assessment confirmed a first episode of HIV-associated psychosis, with an additional diagnosis of HIV-associated mild neurocognitive disorder accompanied by confabulations. The pattern of cognitive impairment differed from that seen in schizophrenia, and magnetic resonance imaging (MRI) revealed no significant findings. Risperidone 6 mg caused mild extrapyramidal symptoms, so the dose was reduced to 5 mg, which was well tolerated; the patient was discharged after two weeks with an improvement in psychotic symptoms, although insight remained poor. The review highlights that anxiety and depression occur in up to 80% of PLWH and HIV-associated neurocognitive disorders in up to 50%, and that careful antipsychotic selection and, in some cases, therapeutic drug monitoring (TDM) are useful for minimizing adverse effects. The authors recommend starting at a low dose, titrating slowly, favoring second-generation antipsychotics, monitoring drug interactions, and ensuring multidisciplinary collaboration.

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