The co-occurrence of psychiatric illness and HIV is common, and each serves as an independent risk factor for the other. As a result, psychotropic medications and antiretroviral therapy therapies are often coprescribed. Drugs used to treat HIV have been associated with pharmacokinetic drug interactions involving the cytochrome P450 isoenzyme system, and most categories of psychotropic drug can interact with antiretroviral therapy (ART) agents prescribed to treat HIV. The clinical impact of these interactions can range from negligible effects on plasma concentrations to life-threatening torsades de pointes or respiratory depression. Knowledge of interactions between psychotropics and antiretrovirals as well as the associated adverse effect potential will help psychiatrists make informed prescribing decisions for this high-risk population.
The objectives of the Psychotropic/Antiretroviral Interactions CME activity are to encourage participants to increase their knowledge of the potential for drug interactions in patients receiving concomitant treatment for mental health disorders and HIV and to integrate this knowledge into clinical practice. More specifically, the program participants will:
- Increase their knowledge about the cytochrome P450 properties of antiretroviral therapies (ART) for HIV.
- Recognize potential interactions between antiretroviral therapies and psychotropic agents including antidepressants, antipsychotics, stimulants, anxiolytics and mood stabilizers, and substance abuse treatments.
- Identify patients who may be at increased risk for interactions.
- Determine and appropriately prescribe therapeutic interventions for patients with comorbid mental health disorders and HIV.
*M.J. Powers & Co. Publishers designates this enduring material for a maximum of 3 AMA PRA Category 1 Credit(s).TM Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Off-Label Usage Disclosure
This activity may discuss commercial products unlabeled for use or an investigational use of a product not yet approved by the United States Food and Drug Administration.
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Please note: activity purchase will appear on your credit card statement as "Learning Express".
- Enduring Material
- Child & Adolescent Psychiatrists
M.J. Powers & Co. Publishers is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Requirements for CE Credit
In order to obtain CME/CEU credit, participants are required to complete all of the following:
1. Read the learning objectives and review the 6 articles on psychotropic/antiretroviral interactions (collected from Psychiatry Drug Alerts).
2. Complete each of the self-study modules (1 for each article).
3. Complete the evaluation form.
Note: 0.5 credits are awarded for completion of each module for a total of 3 credits for completion of the entire activity.
M.J. Powers & Co. Publishers is fully independent and accepts no commercial support of any kind for the development of continuing education activities.
Activity Planning Committee
Trish Elliott, Executive Editor, M.J. Powers & Co. Publishers, Butler, NJ
Tara Hausmann, Associate Editor, M.J. Powers & Co. Publishers, Butler, NJ
Bennett Silver, MD, Private Practice, Springfield, NJ
Kate Casano, MSHyg, M.J. Powers & Co. Publishers, Butler, NJ
Donna Foehner, Assistant Editor, M.J. Powers & Co. Publishers, Butler, NJ
Consulting Editor and CME Reviewer
This activity was reviewed for relevance, accuracy of content, and balance of presentation by Steven J. Schleifer, MD, Clinical Professor of Psychiatry, Rutgers-New Jersey Medical School, Newark, NJ.
Kate Casano has no relevant financial relationships.
Trish Elliott has no relevant financial relationships.
Donna Foehner has no relevant financial relationships.
Tara Hausmann has no relevant financial relationships.
Steven J. Schleifer, MD has no relevant financial relationships.
Bennett Silver, MD has no relevant financial relationships.
- To get started, scroll down and click on the Purchase Now button. NOTE: The charge will appear on your credit card statement as "Learning Express".
- After you have completed the purchase process, select the program, and then select Part 1.
- Click on the + symbol (to the left of the module number) to view a link to the corresponding presentation material. Clicking on the link will open the the material in a new window. Toggle between windows or print the presentation material for your reference.
- Return to this page and click on the Take the Test button.
- Now read each story in the newsletter, and then answer the corresponding questions in the test.
- Repeat for each of the 6 modules. All 6 modules do not need to be taken at once; however partially completed test modules will not be saved.
- After you have passed the final test module, be sure to complete the evaluation form in order to access your certificate.
- Go to View/Print CE Credit in order to access your certificate.
An important feature that distinguishes antiretrovirals from each another is their pharmacokinetic profile with respect to hepatic metabolism via the cytochrome P450 (CYP) isoenzyme system. View the Antiretroviral CYP Properties table to learn about individual agents.
Depression is the most common psychiatric comorbidity in patients with HIV. Because depression has been associated with ART nonadherence, it poses a significant health risk to affected individuals, which makes the selection of an appropriate antidepressant regimen essential.
Stimulants have been shown to reduce depression and fatigue an to improve cognitive function in patients with HIV. Among children with HIV, more than 25% are also affected by ADHD, and about half of these children are expected to continue to experience ADHD symptoms into adulthood. Furthermore, recent research has suggested that certain genotypes associated with ADHD may also increase the risk of future HIV acquisition.
Research has shown that patients diagnosed with HIV are at increased risk for both schizophrenia and acute psychosis, and the prevalence of HIV in those with severe mental illness is much higher than in the general population. Despite theoretical interactions between antipsychotics and ART, there is little clinical information available documenting the effects of these interactions.
Anxiety is estimated to affect >10% of patients with HIV. Symptoms are typically worse in patients with symptomatic HIV illness than in those with asymptomatic HIV infection, and severe anxiety has been shown to predict non-adherence to ART. Additionally, the prevalence of bipolar disorder among adults with HIV is 4-times higher than in the general population, possibly due in part to the likelihood that patients with bipolar disorder engage in more risky sexual behaviors and illicit substance use. Given the common co-occurrence of the disorders, it is not unexpected for patients to require concomitant administration of ART and anxiolytics or mood stabilizers.
Intravenous drug use is a significant risk factor for HIV acquisition, and patients with co-occurring alcohol use disorders and HIV are more likely to experience liver damage due to increased risk of hepatitis B or C virus coinfection and/or concurrent hepatotoxic antiretroviral use.Both IV drug use and heavy alcohol consumption have been associated with ART nonadherence.