Polypharmacy in the HIV-infected older adult population

Gleason, Lauren J.; Luque, Amneris E.; Shah, Krupa

doi:10.2147/cia.s37738

Cited by 45 publications

(33 citation statements)

References 130 publications

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“…The medical management of older HIV-positive individuals brings with it the management of polypharmacy. The problems associated with polypharmacy include worse medication adherence, increased risk of adverse drug events, use of inappropriate drugs, hospitalization, geriatric syndromes, and mortality 12–15…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population

Gimeno-Gracia¹,

Crusells-Canales²,

Armesto-Gómez³

et al. 2016

CIA

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BackgroundThe percentage of older HIV-positive patients is growing, with an increase in age-related comorbidities and concomitant medication.ObjectivesTo quantify polypharmacy and profile types of non-antiretroviral drugs collected at community pharmacies in 2014 by HIV-positive individuals on antiretroviral therapy and to compare these findings with those of the general population.MethodsHIV-positive patients (n=199) were compared with a group of patients from the general population (n=8,172), aged between 50 and 64 years. The factors compared were prevalence of polypharmacy (≥5 comedications with cumulative defined daily dose [DDD] per drug over 180), percentage of patients who collected each therapeutic class of drug, and median duration for each drug class (based on DDD). Results were stratified by sex.ResultsPolypharmacy was more common in HIV-positive males than in the male general population (8.9% vs 4.4%, P=0.010). Polypharmacy was also higher in HIV-positive females than in the female general population (11.3% vs 3.4%, P=0.002). Percentage of HIV-positive patients receiving analgesics, anti-infectives, gastrointestinal drugs, central nervous system (CNS) agents, and respiratory drugs was higher than in the general population, with significant differences between male populations. No differences were observed in proportion of patients receiving cardiovascular drugs. The estimated number of treatment days (median DDDs) were higher in HIV-positive males than in males from the general population for anti-infectives (32.2 vs 20.0, P<0.001) and CNS agents (238.7 vs 120.0, P=0.002). A higher percentage of HIV-positive males than males from the general population received sulfonamides (17.1% vs 1.5%, P<0.001), macrolides (37.1% vs 24.9%, P=0.020), and quinolones (34.3% vs 21.2%, P=0.009).ConclusionPolypharmacy is more common in HIV-positive older males and females than in similarly aged members of the general population. HIV-positive patients received more CNS drugs and anti-infectives, specifically sulfonamides, macrolides, and quinolones, but there were no differences in the percentage of patients receiving cardiovascular drugs. It is essential to investigate nonantiretroviral therapy medication use in the HIV-positive population to ensure these patients receive appropriate management.

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Section: Introductionmentioning

confidence: 99%

Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population

Gimeno-Gracia¹,

Crusells-Canales²,

Armesto-Gómez³

et al. 2016

CIA

View full text Add to dashboard Cite

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“…Adverse effects of polypharmacy are well-recognized in aging patients with multimorbidity. One review, for example, noted that polypharmacy in older adults could lead to toxic drug interactions and/or ineffectiveness in achieving therapeutic effects, as well as falls, increased resource utilization, and higher mortality (Gleason, Luque, & Shah, 2013). For PLWH with other chronic conditions, the prevalence of adverse interactions of antiretroviral therapy and non-HIV medications has not been extensively documented, but it has been linked to potentially serious drug interactions and interruptions in antiretroviral therapy (Holtzman et al, 2013; Krentz & Gill, 2016).…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity With HIV: Views of Community-Based People Living With HIV and Other Chronic Conditions

Slomka¹,

Prince-Paul²,

Webel³

et al. 2017

Journal of the Association of Nurses in AIDS Care

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People living with HIV (PLWH) experience an increase in chronic conditions with aging, but little is known about experiences of living with multimorbidity with HIV. Because early palliative care services may improve well-being for individuals with multimorbidity, we planned to test an intervention to provide these services to community-dwelling PLWH with other chronic conditions. To tailor our intervention to the target population, we conducted 4 focus groups (n = 22) that elicited health-related needs, experiences, and views regarding palliative and other health services. We identified 4 themes related to patients’ needs and experiences: views of HIV as background to other chronic conditions, challenges managing medications and provider interactions, concerns about coping with future health needs, and persistence of HIV stigma. In addressing multimorbidity with HIV, providers and patients may benefit from enhanced attention to communication when crossing specialty areas and from additional support to decrease stressors associated with HIV stigma.

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“…The shift towards an older population of HIV-positive adults was largely a result of improvements in survival due to ART and patient care (Antiretroviral Therapy Cohort, 2008). However, older HIV-positive adults are increasingly at risk of multi-morbidity (Miller et al, 2014; Oni et al, 2015; Rodriguez-Penney et al, 2013), polypharmacy (Edelman et al, 2013; Gleason, Luque, & Shah, 2013), and geriatric conditions, such as frailty (Brown & Qaqish, 2006; Greene et al, 2015). In coming years, healthcare for this population will become increasingly complex as it encompasses not only HIV management but also non-AIDS HIV-related conditions associated with advanced aging (Ball, 2014).…”

Section: Discussionmentioning

confidence: 99%

Growing challenges for HIV programmes in Asia: clinic population trends, 2003–2013

Mata¹,

Kumarasamy

et al. 2017

AIDS Care

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The scale-up of antiretroviral therapy (ART) has led to a substantial change in the clinical population of HIV-positive patients receiving care. We describe the temporal trends in the demographic and clinical characteristics of HIV-positive patients initiating ART in 2003–13 within an Asian regional cohort. All HIV-positive adult patients that initiated ART between 2003 and 2013 were included. We summarized ART regimen use, age, CD4 cell count, HIV viral load, and HIV-related laboratory monitoring rates during follow-up by calendar year. A total of 16 962 patients were included in the analysis. Patients in active follow-up increased from 695 patients at four sites in 2003 to 11,137 patients at eight sites in 2013. The proportion of patients receiving their second or third ART regimen increased over time (5% in 2003 to 29% in 2013) along with patients aged ≥50 years (8% in 2003 to 18% in 2013). Concurrently, CD4 monitoring has remained stable in recent years, whereas HIV viral load monitoring, although varied among the sites, is increasing. There have been substantial changes in the clinical and demographic characteristics of HIV-positive patients receiving ART in Asia. HIV programmes will need to anticipate the clinical care needs for their aging populations, expanded viral load monitoring, and, the eventual increase in second and third ART regimens that will lead to higher costs and more complex drug procurement needs.

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Polypharmacy in the HIV-infected older adult population

Cited by 45 publications

References 130 publications

Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population

Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population

Multimorbidity With HIV: Views of Community-Based People Living With HIV and Other Chronic Conditions

Growing challenges for HIV programmes in Asia: clinic population trends, 2003–2013

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