The anti-psychotic drug management of patients with schizophrenia and HIV-1 infection is problematic. Such individuals are prone to extra-pyramidal reactions on account of HIV-1 induced sub-cortical involvement and exacerbation of cognitive impairment due to underlying CNS infection. Compliance with treatment can be problematic due to a disordered mental state and bone marrow toxicity may also result from the combined effects of anti-psychotic and retroviral agents. It is generally thought that atypical anti-psychotic drugs are the treatment of choice in such cases.
We present the case of a 30-year-old man with a history of schizophrenia who was successfully treated with clozapine following an admission to a psychiatric unit with acute confusional symptoms secondary to HIV-related central nervous system (CNS) involvement.