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Mental Health Medications (Non-ARV meds) in Older HIV+ Appear to Cause Cognitive Impairment & Slow Gait Speed - Ethnicity, Insurance Differ in Older HIV Group Taking Mental Health Meds
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"The greater risk of baseline neurocognitive impairment and incident slow gait speed among men on mental health
medications may be the result of differences in toxicity, drug interactions, or persistent mental health symptoms."
from Jules: at the Aging Workshop last week in NYC this was a big topic of discussion with several studies and presenters reporting the very same - that there are numerous types of non ARV medications that in the general public are associated with causing cognitive impairment & then it was suggested that "deprescribing" older HIV+ should be considered - taking less medications. As well there was a study find
AND HIV+ who are taking MORE medications are more likely to fall.....The Impact of Number of Medications on Falls in Aging Persons Living with HIV - every increase in 1 medication increased risk by 10% for a fall - "50, the new 65?" - (09/17/18) HIV+ with falls were on 11.2 medications vs 7.2 medications for those without a fall. HIV+ Females were at a 56% greater risk for a fall. Increased age too increased risk for a fall. in their summary conclusion slide below authors mention that deprescribing should be considered in older aging HIV+, a topic I have mentioned several times was a key focus of discussion at this workshop.
......and this study also reports certain types of non ART medications cause cognitive impairment; which increases odds of falls. HIV doctors are "over" prescribing these drugs !!!! - Cognitive Burden of Common Non-antiretroviral Medications in HIV-Infected Women (WIHS) - (09/11/18)
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Ethnicity, Insurance Differ in Older HIV Group Taking Mental Health Meds
IDWeek 2018, October 3-7, 2018, San Francisco
Mark Mascolini
Hispanics proved half as likely as whites to take mental health medications in a 1035-person US cohort studied by the AIDS Clinical Trials Group (ACTG) [1]. People using Medicare or other public insurance had 2 to 3 times higher odds of using mental health drugs than people with private insurance. The analysis also uncovered differences in neurocognitive impairment and slow gait (a frailty component) according to mental health medication use.
People with HIV often need medication for mental health conditions, noted HAILO study investigators who conducted this analysis. They explored demographics, behavioral data, and baseline and incident conditions in HAILO participants taking such medications, aiming to improve care of mental health disorders in people with HIV.
HAILO (HIV Infection, Aging, and Immune Function Long-term Observational study; ACTG 5322) is a longitudinal cohort of HIV-positive US residents aged 40 or older [2]. For this analysis researchers (1) compared use of mental health medications by sex, (2) assessed yearly gait speed measurements, and (3) evaluated neurocognitive impairment assessed by the ALLRT Neuroscreen. They used multivariable logistic regression to explore associations between mental health medication use and race or ethnicity, insurance status, baseline and incident (developing) slow gait (more than 1 second per meter), and baseline and incident neurocognitive impairment through 4 years. These analyses adjusted for sex, age, race/ethnicity, education, smoking, substance use, alcohol use, and insurance status.
The study group included 1035 people, 19% of them women. Overall median age stood at 51 years. While 48% of participants were white, 30% were black, and 20% Hispanic. Whereas 42% had private insurance, 26% had public insurance, 12% Medicare, and 21% no or unknown insurance.
Men did not differ significantly from women in use of 8 medication groups: first-generation antidepressants, second- and third-generation antidepressants, first-generation antipsychotics, addiction medications, benzodiazepines, buspirone, mood stabilizers/anticonvulsants, and sleep medications. The most-used medications were second- and third-generation antidepressants (12% of men, 13% of women), mood stabilizers (11% of men, 14% of women), and sleep medications (9% of men, 9% of women).
Of the 1035 participants, 356 (34%) used 1 or more mental health medications and the rest used none. A higher proportion of whites used a mental health medication than did not (55% versus 44%), while a higher proportion of Hispanics did not use a mental health drug (23% versus 14%). Higher proportions of people relying on Medicare and other public insurance used a mental health drug than did not, while privately insured people were more likely not to use a mental health drug. Current smokers were more likely to use than not use a mental health drug. Use of these medications did not differ substantially by sex, age, education, or current alcohol use.
Multivariate analysis determined that Hispanics were about half as likely to use mental health medications as whites. Blacks were nonsignificantly less likely than whites to use these drugs. Compared with people using private insurance, those on Medicare were almost 3 times more likely to use mental health meds and people on other public insurance were about twice as likely to use them.
Multivariate modeling also determined that men (but not women) who used mental health medications had twice higher odds of baseline neurocognitive impairment. Both men and women who took these drugs had twice higher odds of slow gait at baseline. Men but not women who used mental health meds had almost twice higher odds of developing slow gait during follow-up. Mental health med use did not independently affect chances of developing neurocognitive impairment.
The HAILO team suggested that higher risk of baseline neurocognitive impairment and incident slow gait in men taking mental health medications may reflect "differences in toxicity, drug interactions, or persistent mental health symptoms" in men using these drugs.
References
1. Mathur S, Roberts-Toler C, Tassiopoulos K, et al. Demographic factors and clinical outcomes associated with mental health medication use in people living with HIV. IDWeek 2018, October 3-7, 2018, San Francisco. Abstract 583. Poster at https://idsa.confex.com/idsa/2018/webprogram/Paper72468.html
2. ACTG Network Trial Update: HAILO A5322. https://actgnetwork.org/newsletter/april2015/hailo-a5322
Demographics and Clinical Outcomes Associated with Mental Health
Medication Use in People Living with HIV
Swati Mathur1, Carla Roberts-Toler2, Katherine Tassiopoulos2, Karl Goodkin3, Milena McLaughlin4,5, Susan L. Koletar6, Kristine M. Erlandson1
1Unversity of Colorado; Harvard T. H. Chan School of Public Health2; East Tennessee State University3; Northwestern Memorial Hospital4;
Midwestern University, Chicago School of Pharmacy5; The Ohio State University Medical Center6
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