The concomitant use of second-generation antipsychotics and long-term antiretroviral therapy may be associated with increased cardiovascular risk

Abstract

To study the effect of concurrent use of second-generation antipsychotics (SGAs) on metabolic syndrome components conferring increased cardiovascular risk in a sample of HIV-infected adults taking ART. A retrospective study of participants consecutively recruited at the UCSD HIV Neurobehavioral Research Program examined effects of combined ART and SGAs on body mass index (BMI), nonfasting serum lipids, diabetes mellitus (DM) incidence, and mean arterial pressure (MAP). Metabolic outcome variables and covariates were compared using t-tests, Chi-squared or Fisher’s exact tests. Linear and logistic multivariable models explored metabolic outcomes for participants taking (SGA+) or not taking (SGA−) concomitant SGAs, after controlling for demographic and HIV disease- and ART-related covariates. Of 2229 HIV-infected participants, 12% (N=258) were treated with SGAs. In multivariable models adjusted for relevant covariates, the SGA+ group had significantly higher mean triglycerides, significantly higher odds of DM, significantly higher mean arterial pressures and marginally higher BMI. Use of SGAs in HIV-infected adults taking ART was independently associated with worse indicators of metabolic syndrome and cardiovascular risk. Aggressive monitoring for the metabolic complications from concurrent SGA and ART is indicated in all patients receiving these medication combinations.

Updates in Psychosomatic Medicine: 2014

“…The articles were Updates in Psychosomatic Medicine related to 15 subspecialties: cardiac psychiatry, [4][5][6][7][8][9] collaborative care/integrated behavioral health, 10,11 emergency psychiatry, 12,13 HIV psychiatry, [14][15][16][17][18][19][20] neuropsychiatry, 21-31 pediatric psychosomatic medicine, 32-36 psychodermatology, [37][38][39][40][41][42][43][44][45] psychonephrology, 46-55 psycho-oncology and palliative care, [56][57][58][59][60][61][62][63][64] serious mental illness, [65][66][67][68][69][70][71][72] somatic symptom disorders, 73 suicide, 74-78 transplant psychiatry, [79][80][81][82][83][84]…”

Nursing Home Residents by Human Immunodeficiency Virus Status: Characteristics, Dementia Diagnoses, and Antipsychotic Use

“…We speculate that it is possible that NHs have less familiarity caring for these younger HIV residents (99% of whom have non‐AD dementia), leading to greater use of APS medications. While combined use of APS medication and ART is associated with adverse effects beyond those observed with APS medication or ART alone, we lacked data on ART use, limiting our ability to understand the frequency of combined use. Still, the study findings highlight the necessity to better prepare NHs and their staff for the expected increasing numbers of aging persons with HIV who will need NH care in the next decade .…”

“…Indeed, the prevalence of APS medications prescribed for residents with dementia is an important NH quality indicator . Furthermore, there are added concerns about APS medication use for HIV+ residents, including drug interactions between second‐generation APS medications and ART use, which may contribute to an increased risk of hyperlipidemia, hypertension, and diabetes …”

“…13,14 Furthermore, there are added concerns about APS medication use for HIV+ residents, including drug interactions between secondgeneration APS medications and ART use, 15 which may contribute to an increased risk of hyperlipidemia, hypertension, and diabetes. 16 This study uses population-based Medicaid and minimum data set (MDS) data along with data from the Centers for Medicaid and Medicare Services' (CMS') Chronic Condition Warehouse (CCW) to identify a population of HIV+ long-stay NH residents in the 14 US states with the highest HIV prevalence. 17 Using these data, we aimed to: (1) understand the prevalence of HIV in NHs from 2001 to 2010; (2) contrast sociodemographic and clinical characteristics of HIV+ and HIV-residents; and (3) using APS medication use as a quality indicator, describe how dementia care may differ by HIV status.…”

Drug–drug interactions and clinical considerations with co-administration of antiretrovirals and psychotropic drugs

“…This gap in knowledge was addressed by a recently published study that looked to retrospectively establish a relationship between concomitant use of ART and secondgeneration antipsychotic agents. 129 The study found that patients taking both ART and second generation antipsychotics were more likely to have higher blood pressure, higher diabetes prevalence, and higher serum triglycerides as compared to those only taking a second generation antipsychotic. These associations remained present after controlling for use of ART regimens containing ritonavir, stavudine, zidovudine, and indinavir.…”