Potentially inappropriate prescriptions and therapeutic complexity in older HIV patients with comorbidities

Hernando, JM Vinuesa; Gimeno-Gracia, Mercedes; Malo, Sara; Sanjoaquín-Conde, Isabel; Crusells-Canales, María José; Letona-Carbajo, Santiago; Gracia-Piquer, Raquel

doi:10.1007/s11096-021-01242-1

Cited by 15 publications

(30 citation statements)

References 27 publications

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“…With regards to constituents of medication regimen included in the definitions, 67.7% of studies (N = 21) specified that the polypharmacy definition included only non-ART medications, while 27% (N = 9) studies included both ART and non-ART medications in their definitions. One study did not specify whether ART and non-ART medications were used as part of the adjudication process of polypharmacy (3.2%) [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, definitions at the upper part of the extreme (such as ≥ 21 medications) are likely misclassify a high proportion of PLWHA with high pill burden but which has not reached the high threshold of 21 medications. Yet other studies employed descriptive terms such as “excessive” [ 11 ] or “severe” (≥ 10 Medications) [ 24 , 27 ], and “higher” [ 40 ] polypharmacy to convey the magnitude of pill burden, but these subcategories were not consistently mentioned across all studies.…”

Section: Discussionmentioning

confidence: 99%

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What is polypharmacy in people living with HIV/AIDS? A systematic review

et al. 2022

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Polypharmacy in people living with HIV/AIDS (PLWHA) is a rising morbidity that exacts hefty economic burden on health budgets in addition to other adverse clinical outcomes. Despite recent advances, uncertainty remains around its exact definition in PLWHA. In this systematic review and Meta-analysis, we explored relevant databases (PUBMED, EMBASE, CROI) for studies evaluating polypharmacy in PLWHA from January 2000 to August 2021 to ascertain the exact numerical threshold that defines this morbidity. Two independent reviewers extracted and reviewed relevant variables for analyses. The review included a total of 31 studies involving n = 53,347 participants with a mean age of 49.5 (SD ± 17.0) years. There was a total of 36 definitions, with 93.5% defining polypharmacy as the concomitant use of 5 or more medications. We found significant variation in the numerical definition of polypharmacy, with studies reporting it as “minor” (N = 3); “major” (N = 29); “severe” (N = 2); “excessive” (N = 1); and “higher” (N = 1). Most studies did not incorporate a duration (84%) in their definition and excluded ART medications (67.7%). A plurality of studies in PLWHA have established that polypharmacy in this cohort of patients is the intake of ≥ 5 medications (including both ART and non-ART). To standardize the approach to addressing this rising morbidity, we recommend incorporation of this definition into national and international PLWHA treatment guidelines.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

What is polypharmacy in people living with HIV/AIDS? A systematic review

et al. 2022

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“…There was a total of 36 de nitions of polypharmacy, with studies further divided based on the magnitude of polypharmacy (Table 1); minor polypharmacy (N = 3); major polypharmacy (N = 29); "severe" polypharmacy (N = 2); "excessive" polypharmacy (N = 1); "higher" polypharmacy (N = 1) (Table 2). Major 29 [2], [6], [8], [15], [17][18][19][20][21][22][23][24][25][26][27][28][29], [31][32][33][34][35][36][37][38][39][40] Severe 2 [23] [26] [39] Excessive 1 [11] Higher 1 [39] Duration of Polypharmacy Amongst the included studies, 16% (N = 5) incorporated the duration of treatment to the de nition of polypharmacy, while a signi cant proportion 84% (N = 26) only provided the numerical de nition of polypharmacy with no additional information on its duration. Gimeno-Gracia et al further strati ed drug exposure based on the following duration: greater than 1 day; greater than 90 days; and greater than 180 days [14,36].…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, de nitions at the upper part of the extreme (such as >21 medications) are likely misclassify a signi cant proportion of PLWHA with high pill burden but which has not reached the high threshold of 21 medications. Yet other studies employed descriptive terms such as "excessive" [11] or "severe" (>10 Medications) [23][26], and "higher" [39] polypharmacy to convey the magnitude of pill burden, but these subcategories were not consistently mentioned across all studies.…”

Section: Discussionmentioning

confidence: 99%

“…With regards to constituents of medication regimen included in the de nitions, 67.7% of studies (N = 21) speci ed that the polypharmacy de nition included only non-ART medications, while 27% (N = 9) studies included both ART and non-ART medications in their de nitions. One study did not specify whether ART and non-ART medications were used as part of the adjudication process of polypharmacy (3.2%) [23].…”

Section: Art or Non-art Medication Polypharmacymentioning

confidence: 99%

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What is Polypharmacy In People Living With HIV/AIDS? A Systematic Review

Danjuma

Khan

Wahbeh

et al. 2021

Preprint

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Polypharmacy in people living with HIV/AIDS (PLWHA) is a rising morbidity that exacts hefty economic burden on health budgets in addition to other adverse clinical outcomes. Despite recent attempts, uncertainty remains around its exact definition in PLWHA. In this synthesis, we explored relevant databases (PUBMED, EMBASE, CROI) for studies evaluating polypharmacy in PLWHA from January 2000 to August 2021. Two independent reviewers extracted and reviewed relevant variables for analyses. The review included a total of 31 studies involving n = 53347 with a mean age of 49.5 (SD±17.0) years. There was a total of 36 definitions, with 93.5% defining polypharmacy as the concomitant use of 5 or more medications. We found significant variation in the numerical definition of polypharmacy, with studies reporting it as “minor” (N = 3); “major” (N = 29); “severe” (N = 2); “excessive” (N = 1); and “higher” (N = 1). Most studies did not incorporate a duration (84%) in their definition and excluded ART medications (67.7%). A plurality of studies in PLWHA have established that polypharmacy in this cohort of patients is the intake of ≥5 non-ART medications. To standardize the approach to addressing this rising morbidity, we recommend incorporation of this definition into national and international PLWHA treatment guidelines.

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

et al. 2023

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Background Older people living with HIV (PLWH) are at increased risks of co-morbidities and polypharmacy. However, little is known about factors affecting their needs and concerns about medicines. This systematic review aims to describe these and to identify interventions to improve medicine optimisation outcomes in older PLWH. Methods and Data Sources Multiple databases and grey literature were searched from inception to February 2022 including MEDLINE, CINAHL, PsycInfo, PsychArticles, the Cochrane Database of Systematic Reviews and the Cochrane Controlled Register of Trials, Abstracts in Social Gerontology, and Academic Search Complete. Eligibility Criteria Studies reporting interventions/issues affecting older PLWH (sample populations with mean/median age ≥ 50 years; any aspect of medicine optimisation, or concerns). Quality assessments were completed by means of critical appraisal checklists for each study design. Title and abstract screening was led by one reviewer and a sample reviewed independently by two reviewers. Full-paper reviews were completed by one author and a 20% sample was reviewed independently by two reviewers. Synthesis Data were extracted by three independent reviewers using standardised data extraction forms and synthesised according to outcomes or interventions reported. Data were summarised to include key themes, outcomes or concerns, and summary of intervention. Results Seventy-nine ( n = 79) studies met the eligibility criteria, most of which originated from the USA ( n = 36). A few studies originated from Australia ( n = 5), Canada ( n = 5), Spain ( n = 9), and the UK ( n = 5). Ten studies originated from Sub-Saharan Africa (Kenya n = 1, South Africa n = 6, Tanzania n = 1, Uganda n = 1, Zimbabwe n = 1). The rest of the studies were from China ( n = 1), France ( n = 1), Germany ( n = 1), Italy ( n = 1), the Netherlands ( n = 1), Pakistan ( n = 1), Switzerland ( n = 1), Saudi Arabia ( n = 1) and Ukraine ( n = 1). Publication dates ranged from 2002 to 2022. Sample sizes ranged from 10 to 15,602 across studies. The factors affecting older PLWH’s experience of and issues with medicines were co-morbidities, health-related quality of life, polypharmacy, drug interactions, adverse drug reactions, adherence, medicine burden, treatment burden, stigma, social support, and patient-healthcare provider relationships. Nine interventions wer...

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Potentially inappropriate prescriptions and therapeutic complexity in older HIV patients with comorbidities

Cited by 15 publications

References 27 publications

What is polypharmacy in people living with HIV/AIDS? A systematic review

What is polypharmacy in people living with HIV/AIDS? A systematic review

What is Polypharmacy In People Living With HIV/AIDS? A Systematic Review

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

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