Polypharmacy, Medication-Related Burden and Antiretroviral Therapy Adherence in People Living with HIV Aged 50 and Above: A Cross-Sectional Study in Hunan, China

Abstract

Purpose People living with HIV (PLWHIV) are susceptible to non-communicable diseases (NCDs) because of aging and infections. This means that the number of non-HIV medications increases, along with issues of polypharmacy and medication-related burden. The purpose of this study was to identify the current situation of polypharmacy and medication-related burden among PLWHIV aged 50 and above, as well as the relation between medication-related burden and antiretroviral therapy (ART) adherence. Patients and Methods A cross-sectional study was conducted with 185 participants recruited from two HIV clinics in Yuelu District Center for Disease Control (CDC) and Changsha First Hospital in Hunan, China. Participants filled questionnaires about comorbidities, polypharmacy, medication-related burden, ART adherence and sociodemographic characteristics. Results Among the participants, 40% were receiving polypharmacy, and PLWHIV, who were female ( β = 5.946; 95% CI = 1.354, 10.541), had a lower monthly income ( β = −4.777; 95% CI = −6.923, −2.632), and took more drugs ( β = 2.200; 95% CI = 1.167, 3.233) were more likely to report a higher level of medication-related burden. The score of ART adherence was negatively associated with medication-related burden ( r s = −0.250 p = 0.001). Conclusion The findings suggest that more attention should be paid to the issues of polypharmacy and targeted interventions should be developed to reduce medication-related burden among older PLWHIV.

Ageing with HIV: Medicine Optimisation Challenges and Support Needs for Older People Living with HIV: A Systematic Review

“…58% of participants knew of the medication file, however, only 40% of pharmacists reported to offering it systematically. 32% of participants would like to use the medication file programme, particularly those with shorter ARV duration, a less often undetectable viral load and those who experience anxiety more often Generalisability of the study results are reduced due to the sample population being predominantly male Zheng et al, 2022 (China) [ 61 ] n = 185 M = 58 years (SD = 7.5) Hospital and community Data were collected using questionnaires The Chinese version of the Living with Medicines Questionnaire version 3 (LMQ-3) and the Centre for Adherence Support Evaluation (CASE) Adherence Index Polypharmacy was reported in 40% of participants. A higher level of medicine-related burden was reported in females, who took more drugs and had a lower monthly income.…”

“…Older PLWH are more likely to be affected by anxiety, depression, cancer, chronic kidney disease (CKD), chronic pain, diabetes, hypertension, osteoporosis, hepatitis B/C infections than HIV-negative individuals [ 31 , 32 , 34 , 36 , 39 , 42 – 45 , 47 , 51 , 55 , 58 , 61 ]. A study comparing HIV-positive older males to their HIV-negative counterparts found that older participants were six times more likely to be diagnosed with osteoporosis [ 31 ].…”

“…The average number of concomitant medicines used by older PLWH varies [ 13 , 14 , 32 , 33 , 38 – 40 , 49 , 52 , 61 , 70 , 72 – 74 ]. Several studies have found that older PLWH experience more polypharmacy than HIV-negative participants [ 14 , 29 , 40 , 72 , 75 ].…”

“…With higher prevalence of polypharmacy, drug interactions among older PLWH are common, including those occurring between ARV and non-ARV medicines, or between two or more non-ARV medicines [ 13 , 14 , 29 , 31 , 38 , 40 , 41 , 44 , 46 , 48 , 61 , 64 , 67 , 71 , 74 – 77 ]. A large number of drug–drug interactions have been identified in the ageing HIV population, as demonstrated in several studies reviewed, with up to 2552 potential drug–drug interactions (PDDIs) being identified in 1947 participants [ 13 , 14 , 29 , 44 , 61 , 77 ].…”

Modelling the impact of protein-kinase R allelic variant on HIV biomarkers trajectories by means of latent class mixed models

“…This finding has been observed also in elderly subjects without HIV infection 28 . Otherwise, comorbidities and polypharmacy, could have contributed to a worse immune as well as virologic outcome in older PLWH 29 .…”