Research Article Benzodiazepines and Z-Drug Use among HIV-Infected Patients in Taiwan: A 13-Year Nationwide Cohort Study Han-Ting Wei, 1,2 Mu-Hong Chen, 2 Wing-Wai Wong, 3 Yuan-Hwa Chou, 2,4 Ying-Jay Liou, 2,4 Tung-Ping Su, 2,4 Tzeng-Ji Chen, 5 and Ya-Mei Bai 2,4 1 Department of Psychiatry, Taipei Veterans General Hospital, Yuanshan Branch, Yilan County, Taiwan 2 Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan 3 Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan 4 Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei City, Taiwan 5 Department of Family Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan Correspondence should be addressed to Ya-Mei Bai; ymbi@mail2000.com.tw Received 2 July 2014; Revised 23 October 2014; Accepted 23 December 2014 Academic Editor: Robert Heaton Copyright © 2015 Han-Ting Wei et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Benzodiazepines (BZDs) and zolpidem, zopiclone, and zaleplon (Z-drugs) are commonly prescribed to HIV-infected patients. We hypothesized that frequent BZD and Z-drug use among these patients may be associated with psychiatric illnesses, particularly in long-term users. Methods. We included 1,081 patients with HIV between 1998 and 2011 from the Taiwan National Health Insurance Research Database and matched them according to age, sex, and comorbidity with uninfected controls to investigate the psychiatric diagnoses and prescriptions of BZDs and Z-drugs. Cumulative deined daily dose (cDDD) was assessed as the indicator of the duration of medication exposure. Patients exhibiting a cDDD exceeding 180 were deined as long-term users. Results. he patients with HIV had an increased risk of any use (odds ratio (OR): 8.70, 95% conidence interval (CI): 6.82–10.97) and long-term use (OR: 5.06, 95% CI: 3.63–7.04) of BZD and Z-drugs compared with those without HIV during the follow-up ater demographic data and psychiatric comorbidities were adjusted. Conclusion. A large proportion of the HIV-infected patients received prescriptions of BZDs and Z-drugs. Mood disorders, insomnia, anxiety disorders, HIV infection, and substance use disorder were substantial predictors among the BZD and Z-drug users. hese indings suggest that providing psychiatric services for HIV-infected patients is vital. 1. Introduction Insomnia and anxiety are common complaints among patients infected with HIV [1–3] who live with the stress of a highly stigmatized and potentially life-threatening physical illness. hese patients experience a considerable psychologi- cal burden that results in a high prevalence of insomnia, anxi- ety, and depression [4, 5]. Rubinstein and Selwyn [6] reported that 73% of 115 HIV-infected outpatients experienced insom- nia. Hudson et al. [7, 8] determined that 77% of 118 HIV- infected women experienced fear and worry, and insomnia and anxiety exerted the most noticeable inluence on their daily lives. herefore, hypnotic and anxiolytic medications such as benzodiazepines (BZDs) and zolpidem, zopiclone, and zaleplon (Z-drugs) are commonly prescribed to HIV- infected patients. A large study evaluating the psychotropic medications of HIV-infected patients found that, among 1,489 patients, 16.7% received anxiolytics and 20.9% received antidepres- sants [9]. However, hypnotic and anxiolytic medications can be misused or be physically and psychologically addictive, increasing the risks of physical harm, dependence, and social harm [10]. Darke et al. [11] reported that BZD users exhibited high-HIV-risk behaviors, such as sharing injection equipment with numerous people and injecting themselves with multiple drugs. Furthermore, a new class of hypnotic Z- drugs reportedly has a considerably high prevalence of mis- use, abuse, and dependence among the general population; Hindawi Publishing Corporation BioMed Research International Volume 2015, Article ID 465726, 5 pages http://dx.doi.org/10.1155/2015/465726