Ageing with <scp>HIV</scp>: do comorbidities and polymedication drive treatment optimization?

Cuzin, Lise; Katlama, Christine; Cotte, Laurent; Puglièse, Pascal; Chéret, Antoine; Bernaud, C; Rey, David; Poizot‐Martin, Isabelle; Chirouze, Catherine; Bani‐Sadr, Firouzé; Cabie, André

doi:10.1111/hiv.12441

Cited by 21 publications

(11 citation statements)

References 24 publications

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“…As summarized in Table 1, commonly observed comorbidities which may contribute to the issue of polypharmacy in ageing PLWH are hypertension, dyslipidaemia, diabetes mellitus, kidney disease, cardiovascular disease, respiratory disorders, bone disorders or cancer. Of interest, several studies have reported a higher prevalence of comorbidities in PLWH compared to age-matched uninfected individuals [5,[19][20][21][22][23][24][25][26][27]. Furthermore, multimorbidity defined by the concurrent presence of ≥2 comorbidities has been shown to be significantly higher in PLWH compared to uninfected controls, particularly in those with a long history of HIV infection [5,19,25].…”

Section: Comorbidities Among Hiv-positive Individualsmentioning

confidence: 99%

The challenge of HIV treatment in an era of polypharmacy

2020

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Introduction The availability of potent antiretroviral therapy has transformed HIV infection into a chronic disease such that people living with HIV (PLWH) have a near normal life expectancy. However, there are continuing challenges in managing HIV infection, particularly in older patients, who often experience age‐related comorbidities resulting in complex polypharmacy and an increased risk for drug‐drug interactions. Furthermore, age‐related physiological changes may affect the pharmacokinetics and pharmacodynamics of both antiretrovirals and comedications thereby predisposing elderly to adverse drug reactions. This review provides an overview of the therapeutic challenges when treating elderly PLWH (i.e. >65 years). Particular emphasis is placed on drug‐drug interactions and other common prescribing issues (i.e. inappropriate drug use, prescribing cascade, drug‐disease interaction) encountered in elderly PLWH. Discussion Prescribing issues are common in elderly PLWH due to the presence of age‐related comorbidities, organ dysfunction and physiological changes leading to a higher risk for drug‐drug interactions, drugs dosage errors and inappropriate drug use. Conclusions The high prevalence of prescribing issues in elderly PLWH highlights the need for ongoing education on prescribing principles and the optimal management of individual patients. The knowledge of adverse health outcomes associated with polypharmacy and inappropriate prescribing should ensure that there are interventions to prevent harm including medication reconciliation, medication review and medication prioritization according to the risks/benefits for each patient.

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Section: Comorbidities Among Hiv-positive Individualsmentioning

confidence: 99%

The challenge of HIV treatment in an era of polypharmacy

2020

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“…Even with adequate treatment, about 10% of patients had detectable VL and TCD4 + lymphocyte count below 500 cells/mm3 (43%). As the aging of people living with HIV/AIDS has been poorly studied and most randomized studies do not include older adults, it is not known for sure what would be the most appropriate therapeutic scheme, taking into account the physiological changes of aging, the frequent use of several medications for chronic comorbidities and treatment adherence 9,17,18 .…”

Section: Discussionmentioning

confidence: 99%

Perfil epidemiológico dos pacientes idosos com HIV em um centro de referência de Aracaju-SE

Dantas

Moura

Silveira

et al. 2020

Rev Epidemiol Control Infect

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Justificativa e Objetivos: A Síndrome da Imunodeficiência Adquirida (SIDA) é uma doença causada pelo HIV. Das pessoas vivendo com HIV (PVHIV) no Brasil, 3% apresentam 60 anos ou mais. Apesar dos idosos corresponderem a um pequeno percentual, há aumento significativo da incidência nesse grupo nos últimos anos. Dessa forma, a infecção pelo HIV em idosos é uma realidade, contudo, a literatura pouco aborda esse tema. O objetivo do trabalho é estudar o perfil clínico epidemiológico dos idosos vivendo com HIV acompanhados em um centro de referência. Métodos: Trata-se de um estudo observacional, descritivo, de corte transversal, com coleta de dados obtida através dos prontuários do ambulatório de IST/SIDA de um centro de referência. Os dados sociodemográficos, clínicos e laboratoriais, foram coletados no período setembro de 2018 a fevereiro de 2019. Resultados: No centro de referência, estão cadastrados 309 idosos, representando 6,7% de todos os pacientes matriculados no serviço. Destes, 75,6% são homens, 38% casados, 70% de orientação heterossexual e aproximadamente 50% com baixa escolaridade. Comorbidades estão associadas, sendo a dislipidemia (54%) a principal. No momento do diagnóstico, 65,8% apresentavam carga viral (CV) detectável, 62% tinham células CD4+ < 500 céls/mm³ e após seguimento terapêutico apenas 20% apresentavam CV detectável. Vários esquemas terapêuticos foram utilizados, sendo o principal Tenofovir, Lamivudina e Efavirenz (35,3%). Conclusão: O perfil epidemiológico da população atendida na região segue as características nacionais e mundiais, com predomínio de homens, heterossexuais, casados e de baixa escolaridade.

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“…The score presented here could be useful when assessing individual risk-benefit ratios, by improving the accuracy of mortality risk assessment, or to define populations that may benefit the most from intervention. Such a score may reflect the extra burden of multimorbidity and polypharmacy in the aged PLHIV population [ 2 , 30 ] and could be associated with frailty measures [ 31 – 33 ].…”

Section: Discussionmentioning

confidence: 99%

Derivation and internal validation of a mortality risk index for aged people living with HIV: The Dat'AIDS score

Hentzien

Delpierre

Puglièse³

et al. 2018

PLoS ONE

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ObjectiveThe objective was to develop a multivariable prognostic index for overall mortality over a five-year span integrating classical HIV biomarkers and comorbidities in people living with HIV (PLHIV) aged 60 or older.DesignProspective multicenter cohort study from the French Dat’AIDS cohort.MethodsAll HIV-1 infected patients aged 60 years or older on 1st January 2008 were included. Sociodemographic data, CD4 cell count, CD4 nadir, HIV viral load, history of comorbidities, hepatitis co-infections and laboratory parameters at baseline were considered as potential prognostic variables. Primary outcome was all-cause mortality.ResultsAmong 1415 patients included, we derived a score comprising the following predictors: Age (65–74: 1 point; ≥75: 8 points), CD4 cell count (200–349: 3 points; <200: 6 points), non-HIV related cancer (6 points), cardiovascular disease (8 points), estimated glomerular filtration rate (30–59 mL/min/1.73m2: 5 points; <30mL/min/1.73m2: 16 points), cirrhosis (13 points), low body mass index (<18.5 kg/m2, 10 points), anemia (6 points). Mean observed score was 7.0 ± 8.0 and ranged from 0 to 45. Score categories defined 4 risk groups for mortality: low, moderate, high and very high risk (5-year survival probability 0.95 (95%CI[0.93–0.97]), 0.90 (95%CI[0.87–0.92]), 0.77 (95%CI[0.68–0.84]) and 0.54 (95%CI[0.43–0.63]) respectively). The score showed good discrimination (C-statistic = 0.76) and calibration.ConclusionsWe propose a multivariable prognostic score for mortality among PLHIV aged 60 or over, who will become the predominant population in future years in western populations. It could be a useful tool for research, for developing preventive and treatment strategies according to risk group, and for risk assessment by clinicians.

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Ageing with HIV: do comorbidities and polymedication drive treatment optimization?

Abstract: In ageing HIV-infected patients, especially those with a long history of HIV infection, comorbidities and coprescriptions are highly prevalent.

Cited by 21 publications

References 24 publications

The challenge of HIV treatment in an era of polypharmacy

The challenge of HIV treatment in an era of polypharmacy

Perfil epidemiológico dos pacientes idosos com HIV em um centro de referência de Aracaju-SE

Derivation and internal validation of a mortality risk index for aged people living with HIV: The Dat'AIDS score

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