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

Background: Psychiatric disorders are common among HIV-infected adults, but there are no published data on the metabolic side effects of concurrent use of second-generation antipsychotics (SGAs) with antiretroviral therapy (ART). Methods: A cross-sectional study was conducted in participants consecutively recruited at the UCSD HIV Neurobehavioral Research Program examining the use of SGAs and ART in relation to metabolic outcomes, including body mass index (BMI), serum lipids, diabetes mellitus (DM) diagnosis and mean arterial pressure (MAP). Potentially confounding covariates examined included demographics, psychiatric diagnoses, biomarkers of HIV disease status, type of antiretroviral regimen and hepatitis C coinfection. DSM-IV psychiatric diagnoses were obtained using standardized diagnostic assessments. Metabolic outcome variables and covariates were compared using t-tests, c2 or Fisher’s exact tests. Univariate and linear and logistic multivariable models explored metabolic outcomes for participants taking concomitant SGA (SGA+) or not (SGA-) after controlling for demographic and disease covariates. Results: Among the 2,229 records, 81% were male, 47% Caucasian, median nadir and current CD4 counts were 117 and 436 cells/mm3, respectively. The multivariable models adjusted for relevant covariates showed higher triglycerides (P=0.01), higher odds of DM (OR 2.28, 95% CI 1.29, 4.02; P=0.004) and numerically higher BMI (P=0.06) in the SGA+ group. SGA+ participants had higher MAP (P =0.004) than SGA- participants. Conclusions: Use of SGAs in HIV-infected adults taking ART was independently associated with worse meta-bolic parameters, which might accelerate mortality and morbidity through vascular disease. Further research is needed to investigate possible mechanisms behind, and treatment of the metabolic complications of concurrent SGA and ART use.