Polypharmacy among HIV infected people aged 50 years or older
Abstract
Introduction: Although HAART cannot eradicate HIV, it suppresses viral replication, resulting in a progressive reduction in HIV-related morbidity and mortality. The increase in life expectancy for HIV-infected patients has turned this disease into a chronic disease and, therefore, to the appearance of comorbidities. At the same time there is an increase in the use of concomitant medication, making HIV-infected patient a polymedicated patient.
Objective: To determine the degree of polypharmacy and to describe clinically relevant drug interactions, as well as the comorbidities and adherence to HAART in HIV + patients over 50 years.
Methods: Observational, transversal study. Patients ≥50 years on HAART ambulatory were included. The variables were collected: aged, sex, VL, CD4, comorbidities, ARV, concomitant medication, herbal products and adherence. Patients who did not sign informed consent were excluded.
Results: Were included 154 patients ≥50 years on HAART. The presence of polypharmacy, defined as the use of 5 or more medications including HAART, was 40.3%. 73.4% of the patients had concomitant medication: lipid-lowering agents (33.8%), anxiolytics / sedatives (28.6%), proton-pump inhibitors (26.0%) antihypertensive agents (23.4%). 102 relevant interactions were recorded, finding statistically significant differences in relation to the presence of polypharmacy and pharmacologic drugs classes (p <0.001).
Conclusion: The prevalence of polypharmacy among HIV+ patients ≥50 years is high. Comorbidities, interactions and drugs associated were similar to those described in the literature. It is necessary to establish priorities in relation to drug interactions with polypharmacy and a correct approach to the pathologies that may develop.
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Keywords
- Higly active atiretroviral therapy
- Drug Interactions
- Comorbidities
- Aging
- Polipharmacy
- Drug prescriptions
- HAART
- Pharmacovigilance
Author Biographies
, Complejo Asistencial Universitario de León, Servicio de Farmacia, León, España
Complejo Asistencial Universitario de León, Servicio de Farmacia, León, España
, Complejo Asistencial Universitario de León, Servicio de Farmacia, León, España
Complejo Asistencial Universitario de León, Servicio de Farmacia, León, España
https://orcid.org/0000-0001-5801-6775References
Greene M, Justice AC, Lampiris HW, Valcour V. Management of human immunodeficiency virus infection in advanced age. JAMA 2013; 309:1397. doi:10.1001/jama.2013.2963 https://doi.org/10.1001/jama.2013.2963
The Economist Intelligence Unit. Living and ageing with HIV: challenges in Spain's HIV management. Gilead; 2017. Disponible en: https://perspectives.eiu.com/healthcare/living-hiv-challenges-spains-hiv-management
Sociedad Española de Geriatri'a y Gerontologi'a. Documento de consenso sobre edad avanzada e infección por el VIH. Grupo de expertos de la Secretaría del Plan Nacional sobre el sida (SPNS), Sociedad Española de Geriatri'a y Gerontologi'a (SEGG); 2015. Disponible en https://www.segg.es/media/descargas/Documento-de-edad-avanzada-y-VIH.pdf.
Ministerio de Sanidad, Servicios Sociales e Igualdad; Ministerio de Economía y Competitividad. Vigilancia Epidemiológica del VIH/sida en España. Sistema de Información sobre Nuevos Diagnósticos de VIH y Registro Nacional de Casos de Sida; 2017. Disponible en https://www.mscbs.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vigilancia/InformeVIH_SIDA_2017_NOV2017.pdf
Wutoh AK, Brown CM, Kumoji EK, Daftary MS, Jones T, Barnes NA, et al. Antiretroviral adherence and use of alternative therapies among older HIV-infected adults. J Natl Med Assoc. 2001; 93:243.
Ghidei L, Simone MJ, Salow MJ, Zimmerman KM, Paquin AM, Skarf LM, et al. Aging, antiretrovirals, and adherence: a meta analysis of adherence among older HIV-infected individuals. Drugs Aging. 2013; 30:809. doi: 10.1007/s40266-013-0107-7 https://doi.org/10.1007/s40266-013-0107-7
World Health Organization. A Glossary of terms for community health care and services for older persons. Japan: WHO; 2004.
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. doi: 10.1186/s12877-017-0621-2 https://doi.org/10.1186/s12877-017-0621-2
Rollason V, Vogt N. Reduction of polypharmacy in the elderly. A systematic review of the role of the pharmacist. Drugs Aging. 2003;20:817-32. doi:10.2165/00002512-200320110-00003 https://doi.org/10.2165/00002512-200320110-00003
Greene M, Steinman MA, McNicholl IR, Valcour V. Polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults with human immunodeficiency virus infection. J Am Geriatr Soc. 2014; 62:447. doi: 10.1111/jgs.12695 https://doi.org/10.1111/jgs.12695
Greene M, Covinsky KE, Valcour V, Miao Y, Madamba J, Lampiris H, et al. Geriatric Syndromes in Older HIV-Infected Adults. J Acquir Immune Defic Syndr. 2015; 69:161. doi: 10.1097/QAI.0000000000000556 https://doi.org/10.1097/QAI.0000000000000556
Aberg JA. Aging, inflammation, and HIV infection. Top Antivir Med. 2012; 20:101.
Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994; 47(11): 1245-1251. doi: 10.1016/0895-4356(94)90129-5 https://doi.org/10.1016/0895-4356(94)90129-5
Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012; 65(9):989-995. doi: 10.1016/j.jclinepi.2012.02.018 https://doi.org/10.1016/j.jclinepi.2012.02.018
Gimeno-Gracia M, Crusells-Canales MJ, Armesto-Gomez FJ, Compaired-Turlan V, Rabanaque- Hernandez MJ. Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population. Clinical Intervent Aging. 2016;11:1149-57. doi: 10.2147/CIA.S108072. https://doi.org/10.2147/CIA.S108072
HIV Drug Interactions. Having trouble viewing the interactions?. Liverpool, United Kingdom. 2019. Disponible en https://www.hiv-druginteractions.org/checker
Lexi-Comp Online, Lexi-InteractTM Online [Internet database]. Hudson, Ohio: Lexi-Comp, Inc.; 2018. Updated periodically. Disponible en https://www.uptodate.com/drug-interactions/?source=responsive_home#di-druglist
Drugs.com. Drug Interactions CheckerTM. Auckland, New Zealand. 2019. Disponible en: http://www.drugs.com/drug_interactions.html
GESIDA. Recomendaciones GESIDA/SEFH/PNS para mejorar la adherencia al tratamiento antirretroviral. 2008. Disponible en: http://gesida-seimc.org/wp-content/uploads/2017/02/Gesida_dcyrc2008_adherenciaTAR.pdf
Ministerio de Sanidad, Consumo y Bienestar Social; Ministerio de Ciencias, Innovación y Universidades. Encuesta Hospitalaria de pacientes con VIH/sida. Resultados 2018. Análisis de la evolución 2003- 2018. Centro Nacional de Epidemiología- Instituto de Salud Carlos III/ Plan Nacional sobre el Sida- S.G. de Promoción de la salud y Epidemiología. Madrid; 2018. Disponible en: https://www.mscbs.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vigilancia/InformeEncuestaHospitalaria2018_def.pdf.
Gimeno-Gracia M, Crusells-Canales MJ, Armesto-Gomez FJ, Compaired-Turlan V, Rabanaque- Hernandez MJ. Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population. Clin Intervent Aging. 2016;11:1149-57. doi: 10.2147/CIA.S108072. https://doi.org/10.2147/CIA.S108072
Marzolini C, Elzi L, Gibbons S, Weber R, Fux C, Furrer H, et al. Prevalence of comedications and effect of potential drug-drug interactions in the Swiss HIV Cohort Study. Antivir Ther. 2010; 15: 413-23. doi: 10.3851/IMP1540. https://doi.org/10.3851/IMP1540
Teira R, Suarez-Lozano I, Galindo M, Montero M, Geijo P, Muñoz-Sanz A, et al. Changes in the Prevalence of Cardiovascular, Renal and Bone Co-Morbidities and Related Risk Factor in HIV-Infected Patients in The Spanish VACH Cohort: A Cross-Sectional Study in 2010 and 2014. HIV Drug THerapy Glasgow. 23-26 October, Glasgow 2016. Poster ID: P166.
Heron JE, Norman SM, Yoo J, Lembke K, O'Connor CC, Weston CE, et al. The prevalence and risk of non-infectious comorbidities in HIV-infected and non-HIV infected men attending general practice in Australia. PLoS One. 2019;14(10):e0223224. doi: 10.1371/journal.pone.0223224 https://doi.org/10.1371/journal.pone.0223224
Guaraldi G, Orlando G, Zona S, Menozzi M, Carli F, Garlassi E, et al. Premature Age-Related Comorbidities Among HIV-Infected Persons Compared With the General Population, Clinical Infectious Diseases. 2011;53(11): 1120-1126. Doi: 10.1093/cid/cir627 https://doi.org/10.1093/cid/cir627
Schouten J, Wit FW, Stolte IG, Kootstra NA, Van der Valk M, Geerlings SE, et al. Group AGCS Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis. 2014;59(12):1787-1797. doi: 10.1093/cid/ciu701 https://doi.org/10.1093/cid/ciu701
Skiest DJ, Rubinstien E, Carley N, Gioiella L, Lyons R. The importance of comorbidity in HIV-infected patients over 55: a retrospective case-control study. Am J Med. 1996; 101(1996): 605-11. doi. 10.1016/S0002-9343(96)00329-4S https://doi.org/10.1016/S0002-9343(96)00329-4
Tseng A, Szadkowski L, Walmsley S, Salit I, Raboud J. Association of Age With Polypharmacy and Risk of Drug Interactions With Antiretroviral Medications in HIV- Positive Patients. Ann Pharmacother. 2013;47:1429-39. doi: 10.1177/1060028013504075 https://doi.org/10.1177/1060028013504075
Cordova E, Porteiro N, Loiza E, Mingrone H. Prevalence of potential drug-drug interactions involving antiretroviral drugs in Buenos Aires, Argentina. Rev Chilena Infectol. 2016; 33(Suppl 1):54-59. doi.10.4067/S0716-10182016000700006. https://doi.org/10.4067/S0716-10182016000700006
Fairley C, Permana A, Read T. Long-term utility of measuring adherence by self-report compared with pharmacy record in a routine clinic setting. HIV Medicine. 2005; 6: 366-369. doi:10.1111/j.1468-1293.2005.00322.x https://doi.org/10.1111/j.1468-1293.2005.00322.x
Codina C, Martínez M, Tuset M, del Cacho E, Martín MT, Miró JM, et al. Comparación de tres métodos de cálculo de adherencia en pacientes con tratamiento antirretroviral. Enfermedades Infecciosas Microbiola Clín. 2002; 20 (10): 484-490. doi : 10.1016/S0213-005X(02)72850-4 https://doi.org/10.1016/S0213-005X(02)72850-4
Jiménez GR, Montes EIM, Morillo VR. Influence of pharmacotherapy complexity on compliance with the therapeutic objectives for HIV+ patients on antiretroviral treatment concomitant with therapy for dyslipidemia. INCOFAR Project. Farm Hosp. 2016; 40(2):90-6. doi:10.7399/fh.2016.40.2.9932
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