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Detrimental Effects of Psychotropic Medications Differ by Sex in Aging People With HIV

Mathur, Swati MDa; Roberts-Toler, Carla MScb; Tassiopoulos, Katherine ScD, MPHc; Goodkin, Karl MDd; McLaughlin, Milena PharmD, MSce,f; Bares, Sara MDg; Koletar, Susan L. MDh; Erlandson, Kristine M. MD, MSa for the ACTG A5322 Study Team

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 1, 2019 - Volume 82 - Issue 1 - p 88–95
doi: 10.1097/QAI.0000000000002100
Clinical Science
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Background: Mental health conditions are common among persons with HIV (PWH). An understanding of factors associated with prescription medication use for these conditions and clinical impact of the prescription medications may improve care of mental health disorders in PWH.

Methods: Psychotropic medication use was examined among PWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Multivariable logistic models and Cox regression models estimated the association between psychotropic medications (any/none) with baseline and incident slow gait (>1 s/m) and neurocognitive impairment (NCI) for more than 4 years.

Results: Of 1035 participants, the median age was 51 years.81% were men, 30% black, non-Hispanic, and 20% Hispanic. Psychotropic medication use was similar between men (34%) and women (38%; P = 0.19). PWH using psychotropic medications had greater odds of baseline slow gait {odds ratio 1.61, [95% confidence interval (CI): 1.23 to 2.10]; P < 0.001}. Men but not women using psychotropic medications had an increased risk of developing slow gait [hazard ratio 1.85; (1.29 to 2.65) vs 0.77; (CI: 0.35 to 1.68), P interaction = 0.045]. The sex-specific odds ratios for medication use and NCI were qualitatively but not statistically different [men: 1.79; (1.14–2.80); women: 1.27; (0.56–2.90); P interaction = 0.47]. Psychotropic medication use was associated with an increased risk of incident NCI [hazard ratio 2.18; (95% CI: 1.23 to 3.84), P = 0.007] in both men and women.

Conclusions: Psychotropic medications are associated with impairment in functional outcomes of aging, with a greater risk of baseline NCI and incident slow gait among men. Further investigation is needed to optimize outcomes in PWH and prescription of psychotropic medications among both men and women.

aDepartment of Medicine, University of Colorado, Aurora, CO;

bHarvard T. H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, MA;

cDepartment of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA;

dDepartment of Psychiatry and Behavioral Sciences, East Tennessee State University, Johnson City, TN;

eNorthwestern Memorial Hospital, Chicago, IL;

fChicago College of Pharmacy, Midwestern University, Downers Grove, IL;

gDepartment of Medicine, University of Nebraska Medical Center, Omaha, NB; and

hDepartment of Medicine, The Ohio State University Medical Center, Columbus, OH.

Correspondence to: Kristine M. Erlandson, MD, MS, Department of Medicine, University of Colorado, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO 80045 (e-mail: Kristine.erlandson@ucdenver.edu).

Supported by the National Institute of Aging (NIA) through K23AG050260 to KME, the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health under Award Numbers UM1 AI068634, UM1 AI068636, and UM1 AI106701. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Presented in part at IDWeek 2018; October 4–7, 2018; San Francisco, CA.

The authors have no conflicts of interest to disclose.

Received February 08, 2019

Accepted April 29, 2019

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