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

Abstract

Background: Mental health (MH) 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 MH 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 sec/m) and neurocognitive impairment (NCI) over 4 years. Results: Of 1,035 participants, the median age was 51. 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 (OR 1.61, [95% CI 1.23-2.10]; p<0.001). Men but not women using psychotropic medications had an increased risk of developing slow gait (hazard ratio 1.85; [1.29-2.65] vs 0.77; [CI 0.35-1.68], p interaction=0.045). The sex-specific ORs 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 (HR 2.18; [95% CI 1.23-3.84], 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.