Polypharmacy, Drug–Drug Interactions, and Inappropriate Drugs: New Challenges in the Aging Population With HIV

Abstract

Background Antiretroviral therapy has transformed HIV infection from a deadly into a chronic condition. Aging people with HIV (PWH) are at higher risk of polypharmacy, potential drug–drug interactions (DDIs), and potentially inappropriate medications (PIMs). This study aims to compare prescribed drugs, polypharmacy, and potential DDIs between young (<65 years old) and elderly (≥65 years old) PWH. The prevalence of PIMs was assessed in elderly. Methods PWH from 2 centers within the Swiss HIV Cohort Study were asked to fill in a form with all their current medications. Polypharmacy was defined as being on ≥5 non-HIV drugs. PIMs were evaluated using Beers criteria. Potential DDIs for the most prescribed therapeutic classes were screened with the Liverpool interaction database. Results Among the 996 PWH included, 122 were ≥65 years old. Polypharmacy was more frequent in the elderly group (44% vs 12%). Medications and potential DDIs differed according to the age group: cardiovascular drugs and related potential DDIs were more common in the elderly group (73% of forms included ≥1 cardiovascular drug; 11% of cardiovascular drugs involved potential DDIs), whereas central nervous system drugs were more prescribed and involved in potential DDIs in younger PWH (26%, 11%). Potential DDIs were mostly managed through dosage adjustments. PIMs were found in 31% of the elderly group. Conclusions Potential DDIs remain common, and PIMs constitute an additional burden for the elderly. It is important that prescribers develop and maintain a proactive approach for the recognition and management of DDIs and other prescribing issues frequently encountered in geriatric medicine.

Potential prescribing issues among older HIV‐infected subjects in a Mediterranean cohort: Does the current prevalence give cause for concern?

“…Since the population studied was American, this result was expected. Data from a Swiss cohort 35 that included a population with similar age and number of comedication to ours, show that the prevalence of PIMs in 122 patients aged ≥65 years based only on the Beer criteria was lower than that observed among our patients based on the Beers and the STOPP criteria, around 1/3 of the population compared with a half, respectively. One of the most important limitations of the Beers criteria would be not only omitting some medications, but also the fact that some medications considered in the Beers criteria are available only in the USA 12,13 .…”

“…Benzodiazepines were the drugs most frequently involved with PIMs in our and the Swiss cohort 35 . These medications are widely prescribed to the patients we attend, and those with long‐term effects should be avoided in elderly patients at risk of falls and in those receiving other drugs that act on the central nervous system.…”

“…Older PLWH are often affected by comorbidities and polypharmacy 25–27 and can therefore be considered an at‐risk population for PPI and, consequently, for ADRs. However, to our knowledge, only 3 published studies have assessed this issue in PLWH 28,29,35 . Our results from the Over50 cohort show that almost all of the patients aged ≥65 years presented at least 1 potential prescribing issue; half had received at least 1 medication that had to be stopped (PIM by Beers or PIP by STOP).…”

Assessing the Mechanism of Fluoxetine-Mediated CYP2D6 Inhibition

“…Patients presenting with several chronic conditions such as psychiatric disorders, cardiovascular disorders, diabetes, and rheumatoid arthritis often require multiple therapeutic approaches, including the use of numerous drugs, to achieve clinical benefits and experience favorable outcomes [ 1 , 2 , 3 , 4 ]. The co-administration of multiple drugs required to treat complex conditions and associated comorbidities can lead to major pharmacokinetic and/or pharmacodynamic drug–drug interactions (DDIs) [ 5 , 6 , 7 ]. These circumstances also impact drug safety, adherence, and efficacy [ 8 , 9 ].…”

Development and validation of a multiplex UHPLC‐MS/MS assay with stable isotopic internal standards for the monitoring of the plasma concentrations of the antiretroviral drugs bictegravir, cabotegravir, doravirine, and rilpivirine in people living with HIV

“…These clinical studies have generally included carefully selected PLWH, who may not reflect the complex situation in a real‐life clinical setting. In particular, drug‐drug interactions (DDIs) are likely to occur, also with LAI‐ARV drugs, and we have at present very limited information on their actual clinical importance, prompting the monitoring of ARV plasma levels when new comedications at risk of DDIs are introduced in patients on LAI‐ARV drugs. Besides, intersubject variability may be more pronounced particularly in special population (ie, underweight or obese patients, hepatic or renal impairment, aging, or pregnancy).…”