Effects of Combined Use of Antiretroviral Agents and Atypical Antipsychotics on Lipid Parameters

Krystal L Edwards,Lauren Snodgrass,Lisa M Chastain,,Amy Martin,Anthony J Busti

doi:10.4172/jaa.1000032

Abstract

Human immunodeficiency virus (HIV) and psychiatric disorders frequently occur together and may result in concurrent use of atypical antipsychotic (AAP) agents and highly active antiretroviral therapy (HAART). Both classes of agents have been shown to cause clinically important dyslipidemia and metabolic dysregulation in a population at high baseline cardiovascular risk. The combined effects of concurrent use of these drug classes on lipids and other metabolic indices remain undetermined. This retrospective cohort included HIV(+) or HIV(-) patients at the Dallas Veterans Affairs Medical Center who received either HAART or AAP agents. Subjects were separated into three groups: HAART+AAP, HAART alone, and a control group of HIV(-) patients taking AAP agents. The combined HAART and AAP use on lipid parameters was examined. Included patients received treatment for at least 12 weeks and had baseline and follow-up lipids within 1 year. A total of 107 male patients were analyzed with a mean age of 51 years. Mean time on HAART regimen was 49 months (HAART+AAP; n=27) and 24 months (HAART alone; n=40), and mean time on AAPs was 20 months (HAART+AAP) and 22 months (AAP alone; n=40). The addition of an AAP agent to medication regimens in HIV(+) patients, resulted in trends toward worsening TC, LDL, and non- HDL cholesterol levels, although not statistically significant. Ratios of TC/HDL were insignificant between groups following initiation of HAART alone, AAP alone, or in combination; however a greater TG/HDL ratio was noted in those receiving HAART+AAP relative to HAART or AAP alone.

Highlights

Human immunodeficiency virus (HIV)-infected patients are commonly burdened with a myriad of psychiatric comorbidities
Managing various target symptoms of these disorders often requires the use of atypical antipsychotic (AAP) agents, which may be co-prescribed with highly active antiretroviral therapy (HAART) in the HIV-infected patient
The primary aim of this study was to determine if combined use of antiretroviral therapy and atypical antipsychotic agents resulted in worsening lipid parameters and other metabolic indices compared to use of antiretroviral therapy or atypical antipsychotic agents alone

Summary

Introduction

Human immunodeficiency virus (HIV)-infected patients are commonly burdened with a myriad of psychiatric comorbidities. Managing various target symptoms of these disorders often requires the use of atypical antipsychotic (AAP) agents, which may be co-prescribed with highly active antiretroviral therapy (HAART) in the HIV-infected patient This combination of medications may cause a theoretical concern given that both of these therapeutic drug classes have been associated with metabolic abnormalities, altered lipid and glucose metabolism [2]. A review article examining the metabolic complications of both HIV and severe mental illness medications suggests a potential increased risk for metabolic abnormalities mediated by inherent physiologic changes as well as medication side effects [6] Both HAART and AAP agents have been shown to cause adverse effects on cardiovascular risk factors such as serum lipids and impaired glucose metabolism [7,8,9,10], the effects of concurrent use on these metabolic indices with both classes of agents has yet to be reported in the literature. We hypothesized that the combined effects of antiretroviral therapy and atypical antipsychotic therapies on lipid parameters were additive

Objectives

Methods

Results

Discussion

Conclusion