title: 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 (MetS) components conferring increased cardiovascular risk in a sample of human immunodeficiency virus (HIV)-infected adults taking antiretroviral therapy (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 MAPs and marginally higher BMI. The use of SGAs in HIV-infected adults taking ART was independently associated with worse indicators of MetS and cardiovascular risk. Aggressive monitoring for the metabolic complications from concurrent SGA and ART is indicated in all patients receiving these medication combinations.
authors.affiliation: Department of Mental Health, AUSL Modena, Modena, Italy; HIV Neurobehavioral Research Program (HNRP), University of California, San Diego (UCSD), 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA. Electronic address: maria.ferrara@live.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Ferrara
authors.affiliation: HIV Neurobehavioral Research Program (HNRP), University of California, San Diego (UCSD), 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA.
authors.forename: Anya
authors.initials: A
authors.lastname: Umlauf
authors.affiliation: HIV Neurobehavioral Research Program (HNRP), University of California, San Diego (UCSD), 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Sanders
authors.affiliation: Department of Psychiatry, University of California, San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093-0603, USA; Psychiatry Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116-A), San Diego, CA 92161, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Meyer
authors.affiliation: HIV Neurobehavioral Research Program (HNRP), University of California, San Diego (UCSD), 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA.
authors.forename: John
authors.initials: J
authors.lastname: Allen McCutchan
authors.affiliation: HIV Neurobehavioral Research Program (HNRP), University of California, San Diego (UCSD), 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA.
authors.forename: Nichole
authors.initials: N
authors.lastname: Duarte
authors.affiliation: Psychiatry Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116-A), San Diego, CA 92161, USA; HIV Neurobehavioral Research Program (HNRP), University of California, San Diego (UCSD), 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hampton Atkinson
authors.affiliation: HIV Neurobehavioral Research Program (HNRP), University of California, San Diego (UCSD), 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA.
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
authors.affiliation: HIV Neurobehavioral Research Program (HNRP), University of California, San Diego (UCSD), 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ellis
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors
chemical_list: D044966:Anti-Retroviral Agents; D014150:Antipsychotic Agents
keywords: Cardiovascular risk; Diabetes mellitus; HIV; Hypertension; Hypertriglyceridemia; Obesity; Serious mental illness