Prevalence of prescription of the Top-10 drug classes to avoid in elderly people living with HIV in a real practice cohort

Abstract

Objectives. We assessed the prevalence of potentially inappropriate prescriptions (PIP) among older (≥ 65 years) people living with HIV (PLWHIV). Additionally, the secondary objective was to analyse the relationship between pharmacotherapeutic complexity and compliance with STOPP-Beers criteria associated with Top-10 drugs classes to avoid (TOP-10-A) of European AIDS Clinical Society (EACS) guidelines. Methods. This was a cross-sectional observational single-centre study. PLWHIV aged 65 years-old or over on ART attending at hospital pharmacy outpatient service from December-2019 to March-2020 were included. Patients were classified by age group: 65-69, 70-75 and more than 75 years. Moreover, was analysed the relationship between pharmacotherapeutic complexity and compliance with STOPP-Beers Criteria associated with Top-10-A drugs. Results. A total of 19 individuals were included. Overall polypharmacy was observed in 16 PLWHIV (84.2%). A PIP included Top-10-A was identified in 9 (47.4%) PLWHIV. Benzodiazepines were the most prevalent group of prescribed drugs in 6 patients (30.0%). Complex patients were observed in 57.9% (MRCI index value greater than 11.25). Similarly, the sum of criteria STOPP-Beers was higher in older patients. Student’s t test showed the existence of a statistically significant relationship between pharmacotherapeutic complexity and sum of STOPP-Beers Criteria (p <0.05) in elderly PLWHIV. Conclusions. Prescription of PIPs is highly prevalent in older PLWHIV. Consistent with data, presence of PIPs were associated a presence of higher pharmacotherapeutic complexity and sum of STOPP-Beers Criteria. The basis for a new revised care plan for PLWHIV focussed on optimising overall patient care pharmacotherapeutic complexity and its possible consequences.

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

“…Moreover, there may be other barriers or difficulties relating to not testing, late testing, and failing to attend care services that the study was unlikely to identify due to the sample population Schatz et al, 2022 (South Africa) [ 84 ] n = 161, PLWH > 40 years Community Focus group discussions Participants reported fewer negative consequences of discloser in 2018 compared to 2013. Participants reported positive outcomes such as building trust, and greater support with adherence and medication collection A limitation of the study is that participants in the 2013 focus group were different to those in 2018, which may have influenced the findings Contreras-Macias et al, 2020 (Spain) [ 73 ] n = 19 M = 69.4 years Outpatient Data were obtained from medical records, the electronic prescription programme, and the outpatient dispensing programme Medication Regimen Complexity Index (MRCI), The European AIDS Clinical Society (EACS) guideline of “Selected Top 10 Drug Classes To Avoid (Top-10-A) in elderly PLWHIV”, and the STOPP-Beers criteria Polypharmacy was reported in 84.2% (16) of participants and a Top-10-A potentially inappropriate prescription was evident in 47.4% (9) of participants. The most prevalent group of prescribed drugs were benzodiazepines, reported in 30% (6) of participants.…”

“…The most frequent drugs implicated were testosterone ( n = 20), ibuprofen ( n = 15), zolpidem ( n = 9) and lorazepam ( n = 5) [ 13 ]. Other studies measuring drug–drug interactions have listed the same drug groups, among others, as interacting with ART [ 13 , 14 , 29 , 38 , 40 , 44 , 49 , 61 , 73 , 77 ]. PLWH were more likely to have a high anticholinergic burden, with 17% having a score of ≥ 3, in contrast to 4% seen among HIV-negative participants [ 13 ].…”

“…The STOPP and Beers criteria are validated tools that are useful in identifying PIP, drug–drug interactions, drug-disease interactions, and medicine to avoid in older adults [ 106 ]. Several studies in this review highlighted the usefulness of using such tools and medicine reconciliations in older PLWH [ 13 , 20 , 38 , 49 , 73 ], with the Beers criteria evident in over 50% of participants in two studies and over 60% of participants with the STOPP criteria in one study [ 13 , 38 ]. Moreover, medicine reconciliation leading to an average of two medicines being stopped per patient in one study is incredibly important, particularly when each PIP can increase the likelihood of ADRs by 85% [ 38 ].…”

Potentially Inappropriate Prescribing in Older People Living With HIV: A Scoping Review

“…1). Most studies were single centre 22,29,31–33,39–42,44,45,48–52,54,57,59–66 and conducted in Europe. 13,19,28,30–33,39,41,43–51,53,56–63,65,67 The sample size ranged from 2 to 1292 participants, and the population was majority male.…”

“…Most studies were single centre 22,29,31–33,39–42,44,45,48–52,54,57,59–66 and conducted in Europe. 13,19,28,30–33,39,41,43–51,53,56–63,65,67 The sample size ranged from 2 to 1292 participants, and the population was majority male. Twenty-eight studies were cross-sectional, 19,27,28,30–33,39–41,44,45,47–51,53,55,56,61–67 3 were prospective cohort studies, 43,46,57 3 were prospective intervention studies with no control group, 22,59,60 2 nonrandomized controlled studies, 42,52 and 1 randomized controlled study, 58 1 case–control study, 29 and 1 case-report.…”