Patterns of Co-occurring Comorbidities in People Living With HIV

Francesco, Davide De; Verboeket, Sebastiaan O; Underwood, Jonathan; Bagkeris, Emmanouil; Wit, Ferdinand W. N. M.; Mallon, Patrick; Winston, Alan; Reiss, Peter; Sabin, Caroline; Pharmacokinetic,; study, Clinical Observations in PeoPle Over fiftY

doi:10.1093/ofid/ofy272

Cited by 41 publications

(43 citation statements)

References 27 publications

(34 reference statements)

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“…Of interest, comorbidities have been shown to co‐occur in the same individual in specific patterns. Furthermore, correlations have also been reported between patterns with, for instance a strong association between cardiovascular and metabolic diseases . Finally, comorbidities patterns were shown to have different risk factors with older age and a higher body mass index being risk factors for cardiovascular and metabolic disorders.…”

Section: Discussionmentioning

confidence: 90%

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: Discussionmentioning

confidence: 90%

The challenge of HIV treatment in an era of polypharmacy

2020

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“…For instance, in Canada the number of older adults with HIV has doubled over the past 20 years, and in Western Europe the estimated number of people living with HIV aged 50 years and over has almost quadrupled over the past decade . Despite successful cART, many ageing HIV‐positive patients have developed age‐associated comorbidities such as cardiovascular, metabolic, pulmonary, renal, bone and malignant diseases, and these are often more prevalent compared with HIV‐negative individuals . Risk and management of comorbidities in ageing adults with HIV will continue to evolve as treatment improves and life expectancy increases .…”

Section: Introductionmentioning

confidence: 99%

“…positive patients have developed age-associated comorbidities such as cardiovascular, metabolic, pulmonary, renal, bone and malignant diseases, and these are often more prevalent compared with HIV-negative individuals [7,8]. Risk and management of comorbidities in ageing adults with HIV will continue to evolve as treatment improves and life expectancy increases [5,6].…”

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confidence: 99%

The influence of age‐associated comorbidities on responses to combination antiretroviral therapy in older people living with HIV

et al. 2019

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Introduction Multiple comorbidities among HIV ‐positive individuals may increase the potential for polypharmacy causing drug‐to‐drug interactions and older individuals with comorbidities, particularly those with cognitive impairment, may have difficulty in adhering to complex medications. However, the effects of age‐associated comorbidities on the treatment outcomes of combination antiretroviral therapy ( cART ) are not well known. In this study, we investigated the effects of age‐associated comorbidities on therapeutic outcomes of cART in HIV ‐positive adults in Asian countries. Methods Patients enrolled in the TREAT Asia HIV Observational Database cohort and on cART for more than six months were analysed. Comorbidities included hypertension, diabetes, dyslipidaemia and impaired renal function. Treatment outcomes of patients ≥ 50 years of age with comorbidities were compared with those <50 years and those ≥ 50 years without comorbidities. We analysed 5411 patients with virological failure and 5621 with immunologic failure. Our failure outcomes were defined to be in‐line with the World Health Organization 2016 guidelines. Cox regression analysis was used to analyse time to first virological and immunological failure. Results The incidence of virologic failure was 7.72/100 person‐years. Virological failure was less likely in patients with better adherence and higher CD 4 count at cART initiation. Those acquiring HIV through intravenous drug use were more likely to have virological failure compared to those infected through heterosexual contact. On univariate analysis, patients aged <50 years without comorbidities were more likely to experience virological failure than those aged ≥50 years with comorbidities (hazard ratio 1.75, 95% confidence interval (CI) 1.31 to 2.33, p < 0.001). However, the multivariate model showed that age‐related comorbidities were not significant factors for virological failure (hazard ratio 1.31, 95% CI 0.98 to 1.74, p = 0.07). There were 391 immunological failures, with an incidence of 2.75/100 person‐years. On multivariate analysis, those aged <50 years without comorbidities ( p = 0.025) and age <50 years with comorbidities ( p = 0.001) were less likely to develop immunological failure compared to those aged ≥50 years with comorbidities. Conclusions In our Asia regional cohort, age‐associated comorbidities did not affect virologic outcomes of cART . Among those with comorbidities, patient...

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“…Significant associations between psychosocial factors and different types of comorbidity were found in this study. Although these findings are in line with reports from other studies , the nature of these associations is likely to be bidirectional. Further investigation of the cross‐effects between these psychosocial variables and different types of comorbidity would be worthwhile.…”

Section: Discussionmentioning

confidence: 99%

Patterns of comorbidity and sociodemographic and psychosocial correlates among people living with HIV in South Carolina, USA

Yang

Qiao

2019

HIV Medicine

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Objectives Prevention of comorbidity with HIV infection warrants more attention as people living with HIV (PLWH) tend to live longer in the era of effective antiretroviral therapy (ART). This study aimed to investigate the associations between various psychosocial variables and different comorbid conditions in South Carolina (SC), USA. Methods A cross‐sectional survey was conducted among PLWH from May to September 2018 in SC. Comorbid conditions were based on self‐report data and grouped into sexually transmitted infection (STI) comorbidities, noninfectious chronic comorbidities or any comorbidity. Multivariate logistic regression models were used to analyse the relevant associations. Results Among 402 participants, the prevalence of STI comorbidities, noninfectious chronic comorbidities, and any comorbidity was 61.7%, 21.9% and 69.4%, respectively. The multivariate analysis showed that higher depression scores were associated with an increased risk of any comorbidity, while higher anxiety scores were associated with an increased risk of STI comorbidities or any comorbidity. Higher resilience scores were associated with a decreased risk of noninfectious chronic comorbidities or any comorbidity. Conclusions The association between psychosocial factors and different types of comorbidity could inform holistic interventions, such as providing integrated mental health services (e.g. treating mental health problems or building resilience), to effectively cope with and manage the co‐existing medical conditions of PLWH.

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Patterns of Co-occurring Comorbidities in People Living With HIV

Cited by 41 publications

References 27 publications

The challenge of HIV treatment in an era of polypharmacy

The challenge of HIV treatment in an era of polypharmacy

The influence of age‐associated comorbidities on responses to combination antiretroviral therapy in older people living with HIV

Patterns of comorbidity and sociodemographic and psychosocial correlates among people living with HIV in South Carolina, USA

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