Potentially inappropriate medications in older adults living with HIV

Abstract

ObjectivesWe assessed the prevalence of potentially inappropriate medication (PIM) among older (≥ 65 years) people living with HIV (O‐PLWH) in the region of Madrid.MethodsWe analysed the dispensation registry of community and hospital pharmacies from the Madrid Regional Health Service (SERMAS) for the period between 1 January and 30 June 2017, looking specifically at PIMs according to the 2019 Beers criteria. Co‐medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system.ResultsA total of 6 636 451 individuals received medications. Of these individuals, 22 945 received antiretrovirals (ARVs), and of these 1292 were O‐PLWH. Overall, 1135 (87.8%) O‐PLWH were taking at least one co‐medication, and polypharmacy (at least five co‐medications) was observed in 852 individuals (65.9%). A PIM was identified in 482 (37.3%) O‐PLWH. Factors independently associated with PIM were polypharmacy [adjusted odds ratio (aOR) 7.08; 95% confidence interval (CI) 5.16–9.72] and female sex (aOR 1.75; 95% CI 1.30–2.35). The distribution of PIMs according to ATC drug class were nervous system drugs (n = 369; 28.6%), musculoskeletal system drugs (n = 140; 10.8%), gastrointestinal and metabolism drugs (n = 72; 5.6%), cardiovascular drugs (n = 61; 4.7%), respiratory system drugs (n = 13; 1.0%), antineoplastic and immunomodulating drugs (n = 10; 0.8%), and systemic anti‐infectives (n = 2; 0.2%). Five drugs accounted for 84.8% of the 482O PLWH with PIMs: lorazepam (38.2%), ibuprofen (18.0%), diazepam (10.2%), metoclopramide (9.9%), and zolpidem (8.5%).ConclusionsPrescription of PIMs is highly prevalent in O‐PLWH. Consistent with data in uninfected elderly people, the most frequently observed PIMs were benzodiazepines and nonsteroidal anti‐inflammatory drugs . Targeted interventions are warranted to reduce inappropriate prescribing and polypharmacy in this vulnerable population.

Medication burden and clustering in people living with HIV undergoing therapeutic drug monitoring

“…The prevalence of PP we report is similar to what is observed in other cohorts of PLWH 2 but lower than what a US and a Spanish group recently published (32.4%) 8,9 . Despite a small sample size, PP prevalence in PLWH aged above 65 years was 39.6% and significantly higher than that observed in the Italian geriatric GEPPO cohort (approximately 20%) but lower than that reported in a Spanish study (65.9%) 5,10,11 …”

“…8,9 Despite a small sample size, PP prevalence in PLWH aged above 65 years was 39.6% and significantly higher than that observed in the Italian geriatric GEPPO cohort (approximately 20%) but lower than that reported in a Spanish study (65.9%). 5,10,11 While age has constantly been reported as a major risk factor for PP, female gender is not usually recognized as such. [12][13][14][15] In our sample female participants living with HIV were treated with drug classes usually associated with comorbidities more prevalent in women such as thyroid disorders and, not surprisingly, less with drugs used for ischemic cardiac disease (such as antiplatelet agents) or hypertrophic prostate (such as alpha-blockers).…”

“…In the US Veteran study antihypertensives, antilipemic agents and antidepressants, and in a large Spanish study CNS, anti-infective and gastrointestinal agents were recorded as the most common comedications. 5,8 Heterogeneity in inclusion criteria, local prescription and caring habits may explain these differences and may account for distinct DDIs and unwanted outcomes potential. 18 Finally, we observed that certain drugs were more commonly administered together.…”

“…The association between PP and frailty components may be even more frequent in PLWH, according to a recent study in US veteran participants 4 . Additionally using more drugs may expose patients to drug‐to‐drug interactions (DDIs) with potentially serious health hazards 5 . While DDIs seem less common with modern ARVs, there are some manageable but unavoidable interactions and some patients require boosting agents; the latter have been associated with a higher risk of DDI due to cytochromes and transporters inhibition 6 …”

“…4 Additionally using more drugs may expose patients to drug-to-drug interactions (DDIs) with potentially serious health hazards. 5 While DDIs seem less common with modern ARVs, there are some manageable but unavoidable interactions and some patients require boosting agents; the latter have been associated with a higher risk of DDI due to cytochromes and transporters inhibition. 6 While the clustering of comorbidities has already been studied, little is known about how co-medications cluster in PLWH and controls.…”