Effect of second generation antipsychotics on metabolic variables in HIV-infected adults on long term antiretroviral therapy.

Type: Poster
Title: Effect of second generation antipsychotics on metabolic variables in HIV-infected adults on long term antiretroviral therapy.
Authors: Ferrara M, Umlauf A, FitzSimons C, Meyer J, Duarte N, Atkinson JH, Grant I, Ellis R, for the CHARTER Group
Date: 07-22-2012
Abstract:Background: Psychiatric disorders are common among HIV-infected adults, but there is no data on the interaction between the metabolic side effects of antiretroviral therapy (ART) and those of second-generation antipsychotics (SGAs). Methods: A cross sectional study was conducted in participants consecutively recruited at the UCSD HIV Neurobehavioral Research Program examining use of SGAs and ART, metabolic outcomes, biomarkers of HIV disease, and hepatitis C (HCV) serostatus. Psychiatric diagnoses were obtained using standardized psychodiagnostic assessment for DSM-IV disorders. Metabolic outcome variables and covariates were compared for participants taking concomitant SGA (SGA+) or not (SGA-) using t-tests, Chi-squared or Fisher's exact tests. Linear and logistic multivariate models explored between-group outcome, after controlling for demographic and disease covariates. Results: Participants were 2229 research volunteers, 81% were men, 47% were Caucasian, with a median nadir and current CD4 respectively of 117 and 436 cells/mm3. Compared to the SGA- group (n=1971), the SGA+ group (n=258, 11.6% of the total sample) had a significantly higher proportion of female (25% vs. 18%) and African American (40% vs. 32%) participants than the SGA- group. Groups did not differ significantly on age, nadir or current CD4 cell counts, or HIV viral load. SGA+ participants were less likely to be on an efavirenz-containing ART regimen and had a higher prevalence of lifetime substance use disorders, bipolar disorder, and current major depressive disorder. The multivariate model showed higher level of triglycerides (p=0.01), higher odds of diabetes (p=0.004) and numerically higher BMI (p=0.06) in the SGA+ group. SGA+ participants had lower SBP (p=0.02) and higher DBP (p=0.004) than SGAparticipants. Conclusions: Use of SGAs in HIV-infected adults taking ART was independently associated with worse metabolic parameters, which might accelerate mortality and morbidity through vascular disease. Further research is needed to investigate possible mechanisms behind the metabolic complications of SGA and ART use.