HIV prevalence among first-presentation psychotic patients

First-episode psychosis is a frequent emergency department (ED) presentation that may potentially be secondary to an underlying life-threatening HIV-related condition. The aim of this study was to determine the prevalence of HIV infection in patients presenting with a first episode of psychosis.

Medical records of 159 consecutive African, Asian, White and mixed ethnicity patients presenting to a tertiary academic hospital ED with a first episode of psychotic features were prospectively reviewed.

Of the 159 subjects, 63 (39.6%) were HIV positive. An underlying medical condition was the most common aetiology of psychosis in both HIV-positive (84.2%) and HIV-negative (35.4%) subjects, but was significantly more common in HIV-positive individuals (P < 0.001). Substance-induced psychotic disorders and other primary psychiatric disorders were significantly more common in subjects without HIV infection (P < 0.001 and P < 0.001, respectively). While there were more men in the HIV-negative group (66.7%), gender distribution was almost equal in the HIV-infected group (49.2% male). Overall, as well as in both groups, most subjects were of African race, were unemployed and had not completed high school.

Co-occurrence of HIV infection was a frequent finding in first-episode psychotic individuals residing in a high-prevalence HIV setting. These individuals are more likely to have an underlying medical condition precipitating the onset of psychosis, not to have been initiated on antiretroviral therapy and to present with a low CD4 cell count and high HIV viral load.