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

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.