Monitoring in HIV patient populations at risk for metabolic syndrome secondary to concomitant protease inhibitor and second-generation antipsychotic therapy

Purpose: People living with HIV (PLWH) are at a higher risk for metabolic complications secondary to inflammation caused by the virus. Second-generation antipsychotics (SGAs) and protease inhibitors (PIs) cause metabolic side effects. These are compounded with concomitant therapy due to additive effects and pharmacological interactions, potentially increasing serum SGA concentrations. The objective of this study is to explore the prevalence of metabolic syndrome with concurrent SGA and PI therapy and evaluate current risk management practices.

Methods: A retrospective chart review of 200 randomly selected patients taking SGAs and highly active antiretroviral therapy (HAART) for at least six months was conducted. Monitoring for metabolic complications, the prevalence of metabolic syndrome, and dosage adjustments among patients taking SGAs, PIs, or HAART were compared.

Results: Fifty-eight patients met the inclusion criteria for this study. Twenty met metabolic syndrome criteria, but zero had corresponding International Statistical Classification of Diseases (ICD-10) codes listed. Of these 20 patients, 13 took a PI, but none were monitored per the American Diabetes Association (ADA) recommendations. Furthermore, 44 patients took a PI. Most patients took SGAs with the highest metabolic risk, including quetiapine (55.2%) and olanzapine (10.3%). Of patients taking SGAs with recommended dose adjustments, only 3 of 34 (8.8%) were dosed appropriately.

Conclusion: This study highlights the need to develop a system of identifying PLWH undergoing HAART who require close management of metabolic syndrome. The results of this investigation have served as an incentive for heightened observation, including attention to patients’ psychiatric, metabolic, and HIV care.