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Properzi M, Magro P, Castelli F, Quiros-Roldan E. Dolutegravir-rilpivirine: first 2-drug regimen for HIV-positive adults. Expert Rev Anti Infect Ther 2018; 16:877-887. [PMID: 30392419 DOI: 10.1080/14787210.2018.1544491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION New strategies for HIV treatment are being investigated to reduce drug-exposure, toxicities, and costs. Dolutegravir (DTG) 50 mg/rilpivirine (RPV) 25 mg was approved in November 2017 by FDA and in May 2018 by the European Medicines Agency (EMA). It is indicated as a complete regimen for HIV-1 infected adults with undetectable plasmatic HIV-RNA for at least 6 months on their current HIV treatment combination. Its approval was based on the data of two randomized, multicenter, non-inferiority trials (SWORD-1 and SWORD-2). Areas covered: We reviewed data from literature about DTG and RPV. We mainly focused on the efficacy and on the safety of this new dual therapy. Its impact on renal function, its bone and cardiovascular profile, its reservoir penetration and its role on inflammation were also evaluated. Expert commentary: Dual therapies may be an attractive alternative to standard triple regimens in terms of tolerability and simplicity. Long-term efficacy of DTG and RPV dual regimen need to be confirmed, where only the extensive use of this new treatment and a longer follow-up will give us the answers.
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Affiliation(s)
- Martina Properzi
- a Department of Infectious and Tropical Diseases , University of Brescia and ASST Spedali Civili Hospital , Brescia , Italy
| | - Paola Magro
- a Department of Infectious and Tropical Diseases , University of Brescia and ASST Spedali Civili Hospital , Brescia , Italy
| | - Francesco Castelli
- a Department of Infectious and Tropical Diseases , University of Brescia and ASST Spedali Civili Hospital , Brescia , Italy
| | - Eugenia Quiros-Roldan
- a Department of Infectious and Tropical Diseases , University of Brescia and ASST Spedali Civili Hospital , Brescia , Italy
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102
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Ruzicka DJ, Imai K, Takahashi K, Naito T. Greater burden of chronic comorbidities and co-medications among people living with HIV versus people without HIV in Japan: A hospital claims database study. J Infect Chemother 2018; 25:89-95. [PMID: 30396821 DOI: 10.1016/j.jiac.2018.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/11/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study examined the prevalence of chronic comorbidities and the use of co-medications among people living with HIV (PLWH) on antiretrovirals in Japan, compared with age-matched controls without HIV. METHODS This was an observational, retrospective, cross-sectional study using a hospital claims database of Japanese hospitals with advanced medical capabilities (i.e., advanced treatment hospitals, general hospitals, acute care hospitals). We extracted data for PLWH aged ≥18 years with a prescription record of antiretrovirals between January 2010 and December 2015, and for age-, sex-, and hospital-matched people without HIV. For each group, chronic comorbidities (diabetes, hypertension, lipid disorders, vascular diseases, chronic kidney failure, cancers, psychiatric disorders, osteoporosis, and hepatitis B/C co-infection), and co-medications were examined by age group. RESULTS We analyzed data for 1445 PLWH and 14,450 people without HIV. The proportion of patients with multiple comorbidities was much greater among PLWH than controls of the same age group. Lipid disorders and diabetes were more prevalent in PLWH than controls (31.6% vs. 10.3% and 26.8% vs. 13.2%, respectively), both of which were more common in PLWH at earlier ages. Cancer was present in 8.1% of PLWH and 8.9% of controls. A greater proportion of PLWH used multiple co-medications other than antiretrovirals at earlier ages than controls. CONCLUSION PLWH taking antiretrovirals in Japan had a greater burden of comorbidities and co-medications with increasing age than people without HIV. In addition to appropriate management of comorbidities, medication reconciliation according to patients' co-medication profiles is important for successful management of this patient population.
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Affiliation(s)
- Daniel J Ruzicka
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, Japan.
| | - Kentaro Imai
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, USA
| | - Kenichi Takahashi
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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103
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Franconi I, Theou O, Wallace L, Malagoli A, Mussini C, Rockwood K, Guaraldi G. Construct validation of a Frailty Index, an HIV Index and a Protective Index from a clinical HIV database. PLoS One 2018; 13:e0201394. [PMID: 30332410 PMCID: PMC6192552 DOI: 10.1371/journal.pone.0201394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/13/2018] [Indexed: 12/23/2022] Open
Abstract
Background Standard care for HIV clinical practice has started focusing on age-related problems, but despite this recent change physicians involved in HIV care do not often screen HIV patients for frailty. Our aim was to construct three indexes from an HIV clinical database (i.e. Frailty Index, (FI), HIV Index, (HIVI), and Protective Index (PI)) and to assess levels of frailty, HIV severity and demographic and protective lifestyle factors among HIV patients. Methods and findings We included data from 1612 patients who attended an Italian HIV clinic between September 2016 and December2017 (mean±SD age: 53.1±8 years, 73.9% men).We used 92 routine variables collected by physicians and other health care professionals to construct three indexes: a 72-item FI (biometric, psychiatric, blood test, daily life activities, geriatric syndromes and nutrition data), a 10-item HIVI (immunological, viral and therapeutics) and a 10-item PI (income, education, social engagement, and lifestyle habits data)(the lower the FI and HIVI scores, and the higher the PI scores, the lower the risk for participants).The FI, HIVI and PI scores were 0.19±0.08, 0.48±0.17 and 0.62±0.13, respectively. Men had higher FI (0.19±0.08 vs 0.18±0.08; p = 0.010) and lower HIVI (0.47±0.18 vs 0.50±0.15; p = 0.038) scores than women. FI and HIVI scores both increased 1.9% per year of age (p < 0.001), whereas the PI decreased 0.2% per year (p<0.050). In addition, the FI score increased 1.6% and the PI score decreased 0.5% per year of HIV infection (p < 0.001). Conclusion It is feasible to assess levels of frailty, HIV severity and protective lifestyle factors in HIV patients using data from a clinical database. Frailty levels are high among HIV patients and even higher among older patients and those with a long duration of HIV. Future studies need to examine the ability of the three indices to predict adverse health outcomes such as hospitalization and mortality.
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Affiliation(s)
- Iacopo Franconi
- Infectious Diseases Unit, The University of Modena and Reggio Emilia, Modena, Italy
- * E-mail:
| | - Olga Theou
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University& Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Lindsay Wallace
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University& Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Andrea Malagoli
- Infectious Diseases Unit, The University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Infectious Diseases Unit, The University of Modena and Reggio Emilia, Modena, Italy
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University& Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Giovanni Guaraldi
- Infectious Diseases Unit, The University of Modena and Reggio Emilia, Modena, Italy
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104
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Siegler EL, Burchett CO, Glesby MJ. Older people with HIV are an essential part of the continuum of HIV care. J Int AIDS Soc 2018; 21:e25188. [PMID: 30303293 PMCID: PMC6178281 DOI: 10.1002/jia2.25188] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 09/14/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Eugenia L Siegler
- Division of Geriatrics and Palliative MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Chelsie O Burchett
- Division of Geriatrics and Palliative MedicineWeill Cornell MedicineNew YorkNYUSA
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105
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Ware D, Palella FJ, Chew KW, Friedman MR, D’Souza G, Ho K, Plankey M. Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016. PLoS One 2018; 13:e0203890. [PMID: 30204807 PMCID: PMC6133387 DOI: 10.1371/journal.pone.0203890] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/29/2018] [Indexed: 01/21/2023] Open
Abstract
Rates of aging-related comorbidities, which require targeted medications to treat, have been shown to be increased among persons living with HIV compared with uninfected counterparts. Polypharmacy is generally defined as the concurrent use of 5 or more medications. We investigated polypharmacy prevalence for non-HIV medications over a 12-year period among HIV-positive and -negative participants in the Multicenter AIDS Cohort Study. Information regarding non-HIV medication use, HIV status, age, race/ethnicity, enrollment period, and medication insurance was obtained on 3,160 participants from semiannual visits between 2004 and 2016. Polypharmacy was defined as taking 5 or more non-HIV medications since the last health care visit. Generalized estimating equation models with repeated measures were produced overall and by HIV status to examine polypharmacy. The unadjusted prevalence of polypharmacy across all study visits was 18.6% and was higher among HIV-positive participants (24.4%) compared with HIV-negative participants (11.6%) (P < .0001). Among the 50 years and older age group, HIV-positive and HIV-negative participants had increases in polypharmacy over the observation period, from 38.4% to 46.8% (P = .0081) and from 16.7% to 46.0% (P < .0001), respectively. Among participants younger than 50, polypharmacy among HIV-positive participants remained stable (18.9% in 2004 to 17.3% in 2016; P = .5374) but increased among HIV-negative men (5.6% to 20.4%; P < .0001). After adjusting for age, race/ethnicity, and medication insurance, HIV-positive participants had a higher prevalence of polypharmacy than HIV-negative participants (25.3% vs 18.7%; P < .0001). Older age, white race, and having medication insurance coverage were also associated with greater polypharmacy. A convergence of polypharmacy prevalence was observed between HIV-positive and -negative participants at the end of observation. HIV-positive status was associated with an increased likelihood of polypharmacy, after adjusting for age, race/ethnicity, enrollment period, medication insurance, and study visit. Over time, polypharmacy prevalence increased among all participants, with converging rates between HIV-positive and -negative participants by the end of the observation period.
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Affiliation(s)
- Deanna Ware
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
- * E-mail:
| | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Kara W. Chew
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - M. Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Gypsyamber D’Souza
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michael Plankey
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
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106
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Cattaneo D, Giacomelli A, Gervasoni C. Loss of Control of HIV Viremia With OTC Weight-Loss Drugs: A Call for Caution? Obesity (Silver Spring) 2018; 26:1251-1252. [PMID: 30070075 DOI: 10.1002/oby.22240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 01/12/2023]
Abstract
Improved survival achieved by HIV-infected patients has complicated their medical care, as increasing numbers of comorbidities have led to polypharmacy and a higher risk of drug-drug interactions. Here, evidence is provided that weight-loss drugs should be used with caution in HIV-infected patients treated with lipophilic antiretroviral drugs because of the risk of virologic failure. This is particularly relevant considering that these agents are available on the market as over-the-counter medications, thus escaping the control of the physician.
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Affiliation(s)
- Dario Cattaneo
- Gestione Ambulatoriale Politerapie (GAP) outpatient clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Andrea Giacomelli
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Cristina Gervasoni
- Gestione Ambulatoriale Politerapie (GAP) outpatient clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
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107
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Perazzo JD, Webel AR, McGough E, Voss J. People Living With HIV: Implications for Rehabilitation Nurses. Rehabil Nurs 2018; 43:167-173. [PMID: 29710061 DOI: 10.1002/rnj.310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The aim of this study was to present a brief overview of challenges faced by people living with HIV (PLHIV) as they age, to discuss the relevance of HIV to rehabilitation nurses, and to provide evidence-based recommendations for rehabilitation professionals working with PLHIV. DESIGN Current issues article. METHODS Literature review related to age-related comorbidities in PLHIV with implications for rehabilitation nurses. FINDINGS Rehabilitation nurses must be prepared to address issues specific to people living with HIV including sensitivity and privacy regarding HIV status and increased risk of delayed or complicated healing. Rehabilitation nurses should also promote self-management behavior to optimize health in people living with HIV. CONCLUSIONS Understanding unique characteristics of PLHIV as well as applying focused assessment and tailored interventions in PLHIV will give rehabilitation nurses the tools to successfully guide PLHIV through the rehabilitation process and optimize clinical outcomes. CLINICAL RELEVANCE As people with HIV age and experience acute and chronic comorbidities, they will require the clinical expertise of rehabilitation nurses in the process to successfully transition through acute and subacute health care and regain function.
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108
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Ruzicka DJ, Imai K, Takahashi K, Naito T. Comorbidities and the use of comedications in people living with HIV on antiretroviral therapy in Japan: a cross-sectional study using a hospital claims database. BMJ Open 2018; 8:e019985. [PMID: 29903786 PMCID: PMC6009456 DOI: 10.1136/bmjopen-2017-019985] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of chronic comorbidities and the use of comedications in people living with HIV (PLWH) and on antiretrovirals in Japan, by using a hospital claims database. DESIGN Observational, retrospective, cross-sectional study. SETTING A hospital claims database of Japanese hospitals that have advanced medical treatment capabilities (ie, advanced treatment hospitals, general hospitals, acute care hospitals), which include those providing acute and chronic care (excluding nursing homes or hospices). PARTICIPANTS A total of 1445 PLWH aged ≥18 years and with a prescription record of antiretrovirals between January 2010 and December 2015 were identified from the database. OUTCOME MEASURES The number and types of chronic comorbidities, as well as the number and types of comedications, in different age groups of the PLWH. RESULTS The median (range) age of patients was 45 (18-90) years, and 90.4% were men. Of the 1445 patients, 972 (67.3%) had at least one chronic comorbidity. Common chronic comorbidities included lipid disorders (31.6%), diabetes (26.8%), hypertension (18.2%) and hepatitis B/C coinfection (18.2%). Patients in the older age groups had greater numbers of chronic comorbidities. The most common chronic comorbidities in the older age groups were hypertension, diabetes and lipid disorders. The majority of patients used at least one comedication, and those in the older age groups used greater numbers of comedications. The most common therapeutic category of comedication included antacids, antiflatulents and antiulcerants (31.7%). Of 151 malignancies reported in 117 patients, 84 were AIDS-defining cancers and 67 were non-AIDS-defining cancers. CONCLUSIONS Chronic comorbidities and comedications were common among PLWH in Japan taking antiretrovirals; particularly among older patients, who more frequently used comedications. This suggests the need for giving special attention to the appropriate management of this patient population.
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Affiliation(s)
| | - Kentaro Imai
- Oncology Clinical Development, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Toshio Naito
- Department of General Medicine, Juntendo University, Tokyo, Japan
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109
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Radtke KK, Bacchetti P, Anastos K, Merenstein D, Crystal H, Karim R, Weber KM, Edmonds A, Sheth AN, Fischl MA, Vance D, Greenblatt RM, Rubin LH. Use of Nonantiretroviral Medications That May Impact Neurocognition: Patterns and Predictors in a Large, Long-Term HIV Cohort Study. J Acquir Immune Defic Syndr 2018; 78:202-208. [PMID: 29762344 PMCID: PMC5962283 DOI: 10.1097/qai.0000000000001658] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neurocognitive impairment is a frequent and often disabling comorbidity of HIV infection. In addition to antiretroviral therapies, individuals with HIV infection may commonly use nonantiretroviral medications that are known to cause neurocognitive adverse effects (NC-AE). The contribution of NC-AE to neurocognitive impairment is rarely considered in the context of HIV and could explain part of the variability in neurocognitive performance among individuals with HIV. SETTING Women's Interagency HIV Study, a prospective, multisite, observational study of US women with and without HIV. METHODS After a literature review, 79 medications (excluding statins) with NC-AE were identified and reported by Women's Interagency HIV Study participants. We examined factors associated with self-reported use of these medications over a 10-year period. Generalized estimating equations for binary outcomes were used to assess sociodemographic, behavioral, and clinical characteristics associated with NC-AE medication use. RESULTS Three thousand three hundred women (71% with HIV) and data from ∼42,000 visits were studied. HIV infection was associated with NC-AE medication use (odds ratio = 1.52; 95% confidence interval: 1.35 to 1.71). After adjustment for HIV infection status, other predictors of NC-AE medication use included having health insurance, elevated depressive symptoms, prior clinical AIDS, noninjection recreational drug use, and an annual household income of <$12,000 (Ps < 0.004). NC-AE medication use was less likely among women who drank 1-7 or 8-12 alcoholic drinks/week (vs. abstaining) (P < 0.04). CONCLUSIONS HIV infection was associated with NC-AE medication use, which may influence determinations of HIV-associated neurocognitive impairment. Providers should consider the impact of NC-AE medications when evaluating patients with HIV and concurrent neurocognitive symptoms.
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Affiliation(s)
- Kendra K Radtke
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC
| | - Howard Crystal
- Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, NYDepartment of Neurology, Johns Hopkins University, Baltimore, MD
| | - Roksana Karim
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kathleen M Weber
- Cook County Health and Hospital System, Hektoen Institute of Medicine, Chicago, IL
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anandi N Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Margaret A Fischl
- Division of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, FL
| | - David Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL
| | - Ruth M Greenblatt
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA
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110
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Byrne DD, Tate JP, Forde KA, Lim JK, Goetz MB, Rimland D, Rodriguez-Barradas MC, Butt AA, Gibert CL, Brown ST, Bedimo R, Freiberg MS, Justice AC, Kostman JR, Roy JA, Lo Re V. Risk of Acute Liver Injury After Statin Initiation by Human Immunodeficiency Virus and Chronic Hepatitis C Virus Infection Status. Clin Infect Dis 2018; 65:1542-1550. [PMID: 29020184 DOI: 10.1093/cid/cix564] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/27/2017] [Indexed: 12/15/2022] Open
Abstract
Background Patients with human immunodeficiency virus (HIV) and/or chronic hepatitis C virus (HCV) infection may be prescribed statins as treatment for metabolic/cardiovascular disease, but it remains unclear if the risk of acute liver injury (ALI) is increased for statin initiators compared to nonusers in groups classified by HIV/HCV status. Methods We conducted a cohort study to compare rates of ALI in statin initiators vs nonusers among 7686 HIV/HCV-coinfected, 8155 HCV-monoinfected, 17739 HIV-monoinfected, and 36604 uninfected persons in the Veterans Aging Cohort Study (2000-2012). We determined development of (1) liver aminotransferases >200 U/L, (2) severe ALI (coagulopathy with hyperbilirubinemia), and (3) death, all within 18 months. Cox regression was used to determine propensity score-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of outcomes in statin initiators compared to nonusers across the groups. Results Among HIV/HCV-coinfected patients, statin initiators had lower risks of aminotransferase levels >200 U/L (HR, 0.66 [95% CI, .53-.83]), severe ALI (HR, 0.23 [95% CI, .12-.46]), and death (HR, 0.36 [95% CI, .28-.46]) compared with statin nonusers. In the setting of chronic HCV alone, statin initiators had reduced risks of aminotransferase elevations (HR, 0.57 [95% CI, .45-.72]), severe ALI (HR, 0.15 [95% CI, .06-.37]), and death (HR, 0.42 [95% CI, .32-.54]) than nonusers. Among HIV-monoinfected patients, statin initiators had lower risks of aminotransferase increases (HR, 0.52 [95% CI, .40-.66]), severe ALI (HR, 0.26 [95% CI, .13-.55]), and death (HR, 0.19 [95% CI, .16-.23]) compared with nonusers. Results were similar among uninfected persons. Conclusions Regardless of HIV and/or chronic HCV status, statin initiators had a lower risk of ALI and death within 18 months compared with statin nonusers.
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Affiliation(s)
- Dana D Byrne
- Departments of Medicine, Penn Center for AIDS Research.,Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Medicine, Cooper University Hospital, Camden, New Jersey
| | - Janet P Tate
- Veterans Affairs Connecticut Healthcare System, West Haven.,Yale University School of Medicine, New Haven, Connecticut
| | - Kimberly A Forde
- Departments of Medicine, Penn Center for AIDS Research.,Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joseph K Lim
- Veterans Affairs Connecticut Healthcare System, West Haven.,Yale University School of Medicine, New Haven, Connecticut
| | - Matthew Bidwell Goetz
- Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California, Los Angeles
| | - David Rimland
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Georgia
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Adeel A Butt
- Veterans Affairs Pittsburgh Healthcare System, Pennsylvania.,Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar and New York, New York
| | - Cynthia L Gibert
- Washington DC Veterans Affairs Medical Center and George Washington University Medical Center
| | - Sheldon T Brown
- James J. Peters Veterans Affairs Medical Center and Mount Sinai School of Medicine, New York, New York
| | - Roger Bedimo
- Medical Service, Veterans Affairs North Texas Healthcare System.,Department of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amy C Justice
- Veterans Affairs Connecticut Healthcare System, West Haven.,Yale University School of Medicine, New Haven, Connecticut
| | - Jay R Kostman
- John Bell Health Center, Philadelphia Field Initiating Group for HIV Trials, Pennsylvania
| | - Jason A Roy
- Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Vincent Lo Re
- Departments of Medicine, Penn Center for AIDS Research.,Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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111
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Abstract
We conducted a cross-sectional study among HIV-positive adults age ≥ 50 in San Francisco to evaluate the frequency of loneliness, characteristics of those who reported loneliness, and the association of loneliness with functional impairment and health-related quality of life (HRQoL). Participants (N = 356) were predominately male (85%); 57% were white; median age was 56. 58% reported any loneliness symptoms with 24% reporting mild, 22% moderate and 12% severe loneliness. Lonely participants were more likely to report depression, alcohol and tobacco use, and have fewer relationships. In unadjusted models, loneliness was associated with functional impairment and poor HRQoL. In adjusted models, low income and depression remained associated with poor HRQoL, while low income, higher VACS index and depression were associated with functional impairment. A comprehensive care approach, incorporating mental health and psychosocial assessments with more traditional clinical assessments, will be needed to improve health outcomes for the aging HIV-positive population.
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112
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Manzano-García M, Pérez-Guerrero C, Álvarez de Sotomayor Paz M, Robustillo-Cortés MDLA, Almeida-González CV, Morillo-Verdugo R. Identification of the Medication Regimen Complexity Index as an Associated Factor of Nonadherence to Antiretroviral Treatment in HIV Positive Patients. Ann Pharmacother 2018; 52:862-867. [PMID: 29592537 DOI: 10.1177/1060028018766908] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Multiple studies have identified a relationship between the complexity of a medication regimen and non-adherence. However, most studies in people who live with HIV (PLWH) have focused on antiretroviral use and have failed to consider the impact of other medications. OBJECTIVE The aim of our study is to identify the Medication Regimen Complexity Index (MRCI) as an associated factor for nonadherence to antiretroviral treatment (ART). The secondary aim is to analyze the relationship between clinical and pharmacotherapeutical variables and adherence to antiretroviral treatment and to generate an adherence model. METHODS A transversal, observational study. Patients included were PLWH over 18 years of age on active antiretroviral therapy. Patients who participated in clinical trials or who did not meet the inclusion criteria were excluded. We had studied HIV transmission mode, viral load, treatment status, number of comorbidities and complexity index as factors associated with adherence to ART. RESULTS We included 619 patients in the study. Number of comorbidities ( p = 0.021; OR = 1.038-1.570); viral load ( p = 0.023; OR = 1.108-4.505) and MRCI ( p < 0.001; OR = 1.138-1.262) (ART and concomitant treatment) were the independent associated factors to ART nonadherence. The value of the Hosmer and Lemeshow test confirmed the validity of this model (P = 0.333). CONCLUSION A higher MRCI was associated with non-adherence. Therefore, the regimen complexity calculation may be appropriate in daily practice for identifying patients at a higher risk of becoming non-adherent.
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Abstract
Background: HIV-positive individuals (HIV+) on antiretrovirals commonly take enough other medications to cross a threshold for polypharmacy but little is known about associated outcomes. We asked whether non-antiretroviral polypharmacy is associated with hospitalization and mortality and whether associations differ by HIV status. Methods: Data on HIV+ and uninfected individuals in the US Veterans Affairs Healthcare System were analyzed. Eligible HIV+ were on antiretrovirals with suppressed HIV-1 RNA and uninfected individuals received at least one medication. We calculated average non-antiretroviral medication count for fiscal year 2009. As there is no established threshold for non-antiretroviral polypharmacy, we considered more than two and at least five medications. We followed for hospitalization and mortality (fiscal year 2010–2015), adjusting for age, sex, race/ethnicity and VACS Index. Results: Among 9473 HIV+ and 39 812 uninfected individuals respectively, non-antiretroviral polypharmacy was common (>2: 67, 71%; ≥5: 34, 39%). VACS Index discriminated risk of hospitalization (c-statistic: 0.62, 0.60) and mortality (c-statistic: 0.72, 0.70) similarly in both groups. After adjustment, more than two (hazard ratio 1.51, 95% CI 1.46–1.55) and at least five non-antiretrovirals (hazard ratio 1.52, 95% CI 1.49–1.56) were associated with hospitalization with no interaction by HIV status. Risk of mortality associated with more than two non-antiretrovirals interacted with HIV status (P = 0.002), but not for at least five (adjusted hazard ratio 1.43, 95% CI 1.36–1.50). For both groups and both outcomes, average medication count demonstrated an independent, dose response, association. Conclusion: Neither severity of illness nor demographics explain a dose response, association of non-antiretroviral polypharmacy with adverse health outcomes among HIV+ and uninfected individuals.
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Influence of medications on taste and smell. World J Otorhinolaryngol Head Neck Surg 2018; 4:84-91. [PMID: 30035266 PMCID: PMC6051304 DOI: 10.1016/j.wjorl.2018.02.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/27/2018] [Indexed: 01/11/2023] Open
Abstract
Medications frequently have chemosensory side effects that can adversely affect compliance with medical treatment regimens. Hundreds of drugs have been reported to induce unpleasant tastes and/or odors as well as altered chemosensations when administered alone or in combination with other medications. Some chemosensory complaints are due to the sensory properties of the drug itself such as aversive bitter and metallic tastes. However, most chemosensory side effects of drugs are due to alterations in the transduction pathways, biochemical targets, enzymes, and transporters by the offending medications. Studies of chemosensory perception in medicated older individuals have found that taste and smell loss is greatest for those consuming the largest number of prescription drugs. There are no standard treatments for drug-induced chemosensory disorders because each drug has unique biological effects. However, there are a few treatment options to ameliorate chemosensory alterations including addition of simulated flavors to food to compensate for losses and to override offending tastes and smells.
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Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy. AIDS 2018; 32:35-48. [PMID: 29135584 PMCID: PMC5732638 DOI: 10.1097/qad.0000000000001685] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We quantified concomitant medication polypharmacy, pharmacokinetic and pharmacodynamic interactions, adverse effects and adherence in Australian adults on effective antiretroviral therapy. DESIGN Cross-sectional. METHODS Patients recruited into a nationwide cohort and assessed for prevalence and type of concomitant medication (including polypharmacy, defined as ≥5 concomitant medications), pharmacokinetic or pharmacodynamic interactions, potential concomitant medication adverse effects and concomitant medication adherence. Factors associated with concomitant medication polypharmacy and with imperfect adherence were identified using multivariable logistic regression. RESULTS Of 522 participants, 392 (75%) took a concomitant medication (mostly cardiovascular, nonprescription or antidepressant). Overall, 280 participants (54%) had polypharmacy of concomitant medications and/or a drug interaction or contraindication. Polypharmacy was present in 122 (23%) and independently associated with clinical trial participation, renal impairment, major comorbidity, hospital/general practice-based HIV care (versus sexual health clinic) and benzodiazepine use. Seventeen participants (3%) took at least one concomitant medication contraindicated with their antiretroviral therapy, and 237 (45%) had at least one pharmacokinetic/pharmacodynamic interaction. Concomitant medication use was significantly associated with sleep disturbance and myalgia, and polypharmacy of concomitant medications with diarrhoea, fatigue, myalgia and peripheral neuropathy. Sixty participants (12%) reported imperfect concomitant medication adherence, independently associated with requiring financial support, foregoing necessities for financial reasons, good/very good self-reported general health and at least 1 bed day for illness in the previous 12 months. CONCLUSION In a resource-rich setting with universal healthcare access, the majority of this sample took a concomitant medication. Over half had at least one of concomitant medication polypharmacy, pharmacokinetic or pharmacodynamic interaction. Concomitant medication use was associated with several adverse clinical outcomes.
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Aging in HIV-Infected Subjects: A New Scenario and a New View. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5897298. [PMID: 29430462 PMCID: PMC5753008 DOI: 10.1155/2017/5897298] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022]
Abstract
The prevalence of HIV-infected people aged 50 years or older is increasing rapidly; the proportion will increase from 28% to 73% in 2030. In addition, HIV-infected individuals may be more vulnerable to age-related condition. There is growing evidence that the prevalence of comorbidities and other age-related conditions (geriatric syndromes, functional or neurocognitive/mental problems, polypharmacy, and social difficulties) is higher in the HIV-infected population than in their uninfected counterparts. However, despite the potential impact of this situation on health care, little information exists about the optimal clinical management of older HIV-infected people. Here we examine the age-related conditions in older HIV-infected persons and address clinical management according to author expertise and published literature. Our aim is to advance the debate about the most appropriate management of this population, including less well-studied aspects, such as frequency of screening for psychological/mental and social and functional capabilities.
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McNicholl IR, Gandhi M, Hare CB, Greene M, Pierluissi E. A Pharmacist-Led Program to Evaluate and Reduce Polypharmacy and Potentially Inappropriate Prescribing in Older HIV-Positive Patients. Pharmacotherapy 2017; 37:1498-1506. [PMID: 29023938 DOI: 10.1002/phar.2043] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The goal of this pharmacist-led study was to utilize two validated instruments, Beers Criteria and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP), to assess potentially inappropriate prescribing (PIP) in older patients infected with the human immunodeficiency virus (HIV) and evaluate pharmacist interventions. DESIGN Prospective randomized interventional trial. SETTING Large urban clinic providing interdisciplinary primary and HIV care for ~2700 HIV-positive publicly insured patients. DATA SOURCE A computerized electronic record search was conducted for all patients who met the two search criteria: 50 years and older, and a primary care appointment within the last 12 months. PATIENTS After identification of 857 patients meeting the search criteria, 324 patients were randomly selected and contacted, resulting in 248 patients assessed. MEASUREMENTS AND MAIN RESULTS Patients had a mean age of 58 years, 71% male, 44% white, and a mean CD4 count of 536 cells/mm3 . Common comorbidities included hypertension (56%), depression (52%), asthma/chronic obstructive pulmonary disease (48%), dyslipidemia (39%), coronary artery disease (27%), and diabetes (22%). Patients sampled were prescribed a mean of 11.6 ± 5.7 concomitant medications (excluding antiretrovirals) with 35% receiving at least 16 medications. PIP was identified in 54% and 63% of patients using the STOPP and Beers Criteria, respectively. Twenty-five contraindicated drug interactions were identified in 20 patients. After the pharmacist visit, at least 69% of patients had at least one medication discontinued with almost 10% having six or more medications discontinued. More than 40% of patients had at least one Beers or STOPP criteria that required immediate correction by the pharmacist. CONCLUSIONS Results suggest that targeting individuals with 11 or more chronic medications would have the highest yield and greatest impact. Pharmacist-led review of medication prescribing using Beers and STOPP criteria revealed a large number of PIP, many amenable to immediate clinical pharmacist intervention.
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Affiliation(s)
- Ian R McNicholl
- HIV Medical Affairs, Gilead Sciences, Inc., Foster City, California
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California
| | - C Bradley Hare
- Infectious Diseases, Kaiser Permanente, San Francisco, California
| | - Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Edgar Pierluissi
- Division of Geriatrics and Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California at San Francisco, San Francisco, California
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Todd JV, Cole SR, Wohl DA, Simpson RJ, Jonsson Funk M, Brookhart MA, Cocohoba J, Merenstein D, Sharma A, Lazar J, Milam J, Cohen M, Gange S, Lewis TT, Burkholder G, Adimora AA. Underutilization of Statins When Indicated in HIV-Seropositive and Seronegative Women. AIDS Patient Care STDS 2017; 31:447-454. [PMID: 29087746 DOI: 10.1089/apc.2017.0145] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Increased life expectancy of persons living with HIV infection receiving antiretroviral therapy heightens the importance of preventing and treating chronic comorbidities such as cardiovascular disease. While guidelines have increasingly advocated more aggressive use of statins for low-density lipoprotein (LDL) cholesterol reduction, it is unclear whether people with HIV, especially women, are receiving statins when indicated, and whether their HIV disease is a factor in access. We assessed the cumulative incidence of statin use after an indication in the Women's Interagency HIV Study (WIHS), from 2000 to 2014. Additionally, we used weighted proportional hazards regression to estimate the effect of HIV serostatus on the time to initiation of a statin after an indication. Cumulative incidence of statin use 5 years after an indication was low: 38% in HIV-seropositive women and 30% in HIV-seronegative women. Compared to HIV-seronegative women, the weighted hazard ratio for initiation of a statin for HIV-seropositive women over 5 years was 0.94 [95% confidence interval (CI) 0.62, 1.43]. Applying the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines increased the proportion of HIV-seropositive women with a statin indication from 16% to 45%. Clinicians treating HIV-seropositive women should consider more aggressive management of the dyslipidemia often found in this population.
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Affiliation(s)
- Jonathan V Todd
- 1 Institute for Global Health and Infectious Diseases, University of North Carolina , Chapel Hill, North Carolina
- 2 Department of Epidemiology, University of North Carolina , Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Stephen R Cole
- 1 Institute for Global Health and Infectious Diseases, University of North Carolina , Chapel Hill, North Carolina
- 2 Department of Epidemiology, University of North Carolina , Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - David A Wohl
- 1 Institute for Global Health and Infectious Diseases, University of North Carolina , Chapel Hill, North Carolina
| | - Ross J Simpson
- 3 Division of Cardiology, Department of Medicine, University of North Carolina , Chapel Hill, North Carolina
| | - Michele Jonsson Funk
- 2 Department of Epidemiology, University of North Carolina , Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - M Alan Brookhart
- 2 Department of Epidemiology, University of North Carolina , Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Jennifer Cocohoba
- 4 Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy , San Francisco, California
| | - Daniel Merenstein
- 5 Department of Family Medicine, Georgetown University Medical Center , Washington, District of Columbia
| | - Anjali Sharma
- 6 Department of Medicine, Albert Einstein College of Medicine , Bronx, New York
| | - Jason Lazar
- 7 Department of Cardiovascular Disease, SUNY Downstate Medical Center , Brooklyn, New York
| | - Joel Milam
- 8 Department of Preventive Medicine, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Mardge Cohen
- 9 Department of Medicine, Cook County Health and Hospital System and Rush University , Chicago, Illinois
| | - Stephen Gange
- 10 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Tené T Lewis
- 11 Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Greer Burkholder
- 12 Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Adaora A Adimora
- 1 Institute for Global Health and Infectious Diseases, University of North Carolina , Chapel Hill, North Carolina
- 2 Department of Epidemiology, University of North Carolina , Gillings School of Global Public Health, Chapel Hill, North Carolina
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Kim TW, Walley AY, Ventura AS, Patts GJ, Heeren TC, Lerner GB, Mauricio N, Saitz R. Polypharmacy and risk of falls and fractures for patients with HIV infection and substance dependence. AIDS Care 2017; 30:150-159. [PMID: 29034725 DOI: 10.1080/09540121.2017.1384532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although people with HIV infection (PLWH) are at higher risk of polypharmacy and substance use, there is limited knowledge about potential harms associated with polypharmacy such as falls and fractures in this population. The study objective was to determine whether polypharmacy, as measured by the number and type of medication, is associated with falls and fractures among PLWH and DSM-IV substance dependence in the past year or ever injection drug use (IDU). We identified the number of medications by electronic medical record review in the following categories: (i) systemically active, (ii) non-antiretroviral (non-ARV), (iii) sedating, (iv) non-sedating as well as any opioid medication and any non-opioid sedating medication. Outcomes were self-reported (1) fall/accident requiring medical attention and (2) fracture in the previous year. Separate logistic regression models were fitted for medications in each category and each outcome. Among 250 participants, the odds of a fall requiring medical attention were higher with each additional medication overall (odds ratio [OR] 1.12, 95% Confidence Interval [CI] = 1.05, 1.18), each additional non-ARV medication (OR 1.13, 95%CI = 1.06, 1.20), each additional sedating medication (OR 1.36, 95%CI = 1.14, 1.62), and a non-opioid sedating medication (OR 2.89, 95%CI = 1.06, 7.85) but not with an additional non-sedating medication or opioid medication. In receiver operating characteristic (ROC) curve analyses, optimal cutoffs for predicting falls were: ≥8 overall and ≥2 sedating medications. Odds ratios for fracture in the previous year were OR 1.05, 95%CI = 0.97, 1.13 for each additional medication overall and OR 1.11, 95%CI = 0.89, 1.38 for each additional sedating medication. In PLWH and substance dependence or ever IDU, a higher number of medications was associated with greater odds of having a fall requiring medical attention. The association appeared to be driven largely by sedating medications. Future studies should determine if reducing such polypharmacy, particularly sedating medications, lowers the risk of falls.
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Affiliation(s)
- Theresa W Kim
- a Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center , Boston University School of Medicine , Boston , MA , USA
| | - Alexander Y Walley
- a Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center , Boston University School of Medicine , Boston , MA , USA
| | - Alicia S Ventura
- a Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center , Boston University School of Medicine , Boston , MA , USA
| | - Gregory J Patts
- b Data Coordinating Center , Boston University School of Public Health , Boston , MA , USA
| | - Timothy C Heeren
- c Department of Biostatistics , Boston University School Public Health , Boston , MA , USA
| | | | | | - Richard Saitz
- a Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center , Boston University School of Medicine , Boston , MA , USA.,e Department of Community Health Sciences , Boston University School of Public Health , Boston , MA , USA
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Abstract
The objectives of this study, presented as part of a plenary session at WW7 in Hyderabad, India were to review (i) the epidemiology and current clinical issues of HIV infection with regard to HIV and older populations and (ii) models for increased morbidity and mortality in older HIV-positive individuals with implications for clinical care. HIV infection for those in treatment has become a complex chronic disease in which end-organ injury and resulting morbidity, functional decline, and mortality do not have a single etiology but reflect cumulative loss of organ system reserve from multiple interacting sources leading to functional decline, organ system failure, and death. Emerging guidelines and recommendations suggest a need for increased awareness and treatment of the multifaceted needs of the aging HIV-infected patient.
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Affiliation(s)
- M John
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
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121
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Re VL, Zeldow B, Kallan MJ, Tate JP, Carbonari DM, Hennessy S, Kostman JR, Lim JK, Goetz MB, Gross R, Justice AC, Roy JA. Risk of liver decompensation with cumulative use of mitochondrial toxic nucleoside analogues in HIV/hepatitis C virus coinfection. Pharmacoepidemiol Drug Saf 2017; 26:1172-1181. [PMID: 28722244 PMCID: PMC5624832 DOI: 10.1002/pds.4258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/13/2017] [Accepted: 06/13/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE Among patients dually infected with human immunodeficiency virus (HIV) and chronic hepatitis C virus (HCV), use of antiretroviral therapy (ART) containing mitochondrial toxic nucleoside reverse transcriptase inhibitors (mtNRTIs) might induce chronic hepatic injury, which could accelerate HCV-associated liver fibrosis and increase the risk of hepatic decompensation and death. METHODS We conducted a cohort study among 1747 HIV/HCV patients initiating NRTI-containing ART within the Veterans Aging Cohort Study (2002-2009) to determine if cumulative mtNRTI use increased the risk of hepatic decompensation and death among HIV-/HCV-coinfected patients. Separate marginal structural models were used to estimate hazard ratios (HRs) of each outcome associated with cumulative exposure to ART regimens that contain mtNRTIs versus regimens that contain other NRTIs. RESULTS Over 7033 person-years, we observed 97 (5.6%) decompensation events (incidence rate, 13.8/1000 person-years) and 125 (7.2%) deaths (incidence rate, 17.8 events/1000 person-years). The risk of hepatic decompensation increased with cumulative mtNRTI use (1-11 mo: HR, 1.79 [95% confidence interval (CI), 0.74-4.31]; 12-35 mo: HR, 1.39 [95% CI, 0.68-2.87]; 36-71 mo: HR, 2.27 [95% CI, 0.92-5.60]; >71 mo: HR, 4.66 [95% CI, 1.04-20.83]; P = .045) versus nonuse. Cumulative mtNRTI use also increased risk of death (1-11 mo: HR, 2.24 [95% CI, 1.04-4.81]; 12-35 mo: HR, 2.05 [95% CI, 0.68-6.20]; 36-71 mo: HR, 3.04 [95% CI, 1.12-8.26]; >71 mo: HR, 3.93 [95% CI, 0.75-20.50]; P = .030). CONCLUSIONS These findings suggest that cumulative mtNRTI use may increase the risk of hepatic decompensation and death in HIV/HCV coinfection. These drugs should be avoided when alternatives exist for HIV/HCV patients.
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Affiliation(s)
- Vincent Lo Re
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Medical Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Bret Zeldow
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael J. Kallan
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Janet P. Tate
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, New Haven, CT
| | - Dena M. Carbonari
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sean Hennessy
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jay R. Kostman
- John Bell Health Center, Philadelphia Field Initiating Group for HIV Trials, Philadelphia, PA
| | - Joseph K. Lim
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, New Haven, CT
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Robert Gross
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Medical Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, New Haven, CT
| | - Jason A. Roy
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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De La Mata NL, Kumarasamy N, Ly PS, Ng OT, Nguyen KV, Merati TP, Lee MP, Cuong DD, Choi JY, Ross JL, Law MG. Growing challenges for HIV programmes in Asia: clinic population trends, 2003-2013. AIDS Care 2017; 29:1243-1254. [PMID: 28132544 PMCID: PMC5534184 DOI: 10.1080/09540121.2017.1282108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
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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Affiliation(s)
| | | | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | | | | | | | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong SAR, China
| | | | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Jeremy L. Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Matthew G. Law
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
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Abstract
PURPOSE OF REVIEW Evidence-based strategies are needed to address the growing complexity of care of those ageing with HIV so that as life expectancy is extended, quality of life is also enhanced. RECENT FINDINGS Modifiable contributing factors to the quantity and quality of life in adults ageing with HIV include: burden of harmful health behaviours, injury from HIV infection, HIV treatment toxicity and general burden of age-associated comorbidities. In turn, these factors contribute to geriatric syndromes including multimorbidity and polypharmacy, physiologic frailty, falls and fragility fractures and cognitive dysfunction, which further compromise the quality of life long before they lead to mortality. SUMMARY Viral suppression of HIV with combination antiviral therapy has led to increasing longevity but has not enabled a complete return to health among ageing HIV-infected individuals (HIV+). As adults age with HIV, the role of HIV itself and associated inflammation, effects of exposure to antiretroviral agents, the high prevalence of modifiable risk factors for age-associated conditions (e.g. smoking), and the effects of other viral coinfections are all influencing the health trajectory of persons ageing with HIV. We must move from the simplistic notion of HIV becoming a 'chronic controllable illness' to understanding the continually evolving 'treated' history of HIV infection with the burden of age-associated conditions and geriatric syndromes in the context of an altered and ageing immune system.
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Kim TW, Walley AY, Heeren TC, Patts GJ, Ventura AS, Lerner GB, Mauricio N, Saitz R. Polypharmacy and risk of non-fatal overdose for patients with HIV infection and substance dependence. J Subst Abuse Treat 2017; 81:1-10. [PMID: 28847449 DOI: 10.1016/j.jsat.2017.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 07/06/2017] [Accepted: 07/13/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION People living with HIV (PLWH) are at risk of both polypharmacy and unintentional overdose yet there are few data on whether polypharmacy increases risk of overdose. The study objective was to determine if the number and type of medication (e.g., sedating) were associated with non-fatal overdose (OD) among PLWH with past-year substance dependence or a lifetime history of injection drug use. MATERIALS AND METHODS This was a longitudinal study of adults recruited from two urban, safety-net HIV clinics. Outcomes were i) lifetime and ii) past-year non-fatal OD assessed at baseline and a 12-month follow-up. We used logistic regression to examine the association between each outcome and the number of medications (identified from the electronic medical record) in the following categories: i) overall medications, ii) non-antiretroviral (non-ARV), iii) sedating, iv) non-sedating, as well as any vs no opioid medication and any vs no non-opioid sedating medication. Covariates included demographics, medical comorbidities, depressive and anxiety symptoms, and substance use. RESULTS Among 250 participants, 80% were prescribed a sedating medication, 50% were prescribed an opioid; 51% exceeded risky drinking limits. In the past month, 23% reported illicit opioid use and 9% illicit opioid sedative use; 37% reported lifetime non-fatal OD and 7% past-year non-fatal OD. The median number (interquartile range) of total medications was 10 (7, 14) and 2 (1, 3) sedating. The odds of lifetime non-fatal OD were significantly higher with each additional sedating medication (OR 1.26, 95% CI 1.08, 1.46) and any opioid medication (OR 2.31; 95% CI 1.37, 3.90), but not with each overall, non-ARV, or non-sedating medication. The odds of past year non-fatal OD were greater with each additional sedating medication (OR 1.18; 95% CI 1.00, 1.39, p=0.049), each additional non-ARV medication (OR 1.07; 95% CI 1.00, 1.15, p=0.048), and non-significantly for any opioid medication (OR 2.23; 95% CI 0.93, 5.35). CONCLUSIONS In this sample of PLWH with substance dependence and/or injection drug use, number of sedating medications and any opioid were associated with non-fatal overdose; sedating medications were prescribed to the majority of patients. Polypharmacy among PLWH and substance dependence warrants further research to determine whether reducing sedating medications, including opioids, lowers overdose risk.
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Affiliation(s)
- Theresa W Kim
- Clinical Addiction Research and Education (CARE) Unit (TWK, AYW, ASV, RS), Section of General Internal Medicine, Boston University School of Medicine (GBL, NM), Boston Medical Center, Boston, MA, United States.
| | - Alexander Y Walley
- Clinical Addiction Research and Education (CARE) Unit (TWK, AYW, ASV, RS), Section of General Internal Medicine, Boston University School of Medicine (GBL, NM), Boston Medical Center, Boston, MA, United States.
| | - Timothy C Heeren
- Department of Biostatistics (TH), Data Coordinating Center (GJP), Department of Community Health Sciences (RS), Boston University School Public Health, Boston, MA, United States.
| | - Gregory J Patts
- Department of Biostatistics (TH), Data Coordinating Center (GJP), Department of Community Health Sciences (RS), Boston University School Public Health, Boston, MA, United States.
| | - Alicia S Ventura
- Department of Biostatistics (TH), Data Coordinating Center (GJP), Department of Community Health Sciences (RS), Boston University School Public Health, Boston, MA, United States.
| | - Gabriel B Lerner
- Clinical Addiction Research and Education (CARE) Unit (TWK, AYW, ASV, RS), Section of General Internal Medicine, Boston University School of Medicine (GBL, NM), Boston Medical Center, Boston, MA, United States.
| | - Nicholas Mauricio
- Clinical Addiction Research and Education (CARE) Unit (TWK, AYW, ASV, RS), Section of General Internal Medicine, Boston University School of Medicine (GBL, NM), Boston Medical Center, Boston, MA, United States.
| | - Richard Saitz
- Clinical Addiction Research and Education (CARE) Unit (TWK, AYW, ASV, RS), Section of General Internal Medicine, Boston University School of Medicine (GBL, NM), Boston Medical Center, Boston, MA, United States; Department of Biostatistics (TH), Data Coordinating Center (GJP), Department of Community Health Sciences (RS), Boston University School Public Health, Boston, MA, United States.
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Clinical implications of aging with HIV infection: perspectives and the future medical care agenda. AIDS 2017; 31 Suppl 2:S129-S135. [PMID: 28471943 DOI: 10.1097/qad.0000000000001478] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
: The increasing number of aging HIV-infected (HIV+) persons comprises a unique population at risk for illnesses and syndromes traditionally associated with the elderly. As a result, similar to the current need for primary care providers to manage chronic noninfectious comorbidities among aging persons with well controlled HIV infection, HIV clinical care will need to routinely involve geriatric medicine in a new HIV-geriatric discipline. The objective of this article is to provide a conceptual framework in which HIV and geriatric management considerations for healthcare professionals caring for HIV+ persons are integrated. The provision of contemporary HIV clinical care extends well beyond the achievement of HIV virologic suppression and antiretroviral therapy management and includes a need for careful characterization of geriatric syndromes based upon functional capacity and extent of disability. Screening for geriatric syndromes is both a multidisciplinary and multidimensional process, designed to evaluate an older person's functional ability, physical health, cognition, overall mental health, and socio-environmental circumstances. Although routine incorporation of geriatric assessment into clinical trials involving HIV+ persons is feasible, a current challenge is the availability of a consensus clinical definition of frailty or vulnerability. To maximize the efficiency, value, and convenience of outpatient care visits for older HIV+ persons, these visits should include encounters with multiple providers, including primary care clinicians, social workers, and geriatricians. Challenges may exist in the routine provision of these assessments to older HIV+ persons, but clearly such cross-disciplinary collaboration will not only markedly enhance the care of aging HIV+ persons but may also constitute a model of successful healthcare management that can be applied to all aging persons with changing healthcare needs.
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Levy ME, Greenberg AE, Hart R, Powers Happ L, Hadigan C, Castel A. High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC. HIV Med 2017; 18:724-735. [PMID: 28503912 DOI: 10.1111/hiv.12516] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide prevalence of hypertension, type 2 diabetes, dyslipidaemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates. METHODS Utilizing an electronic medical record (EMR) database from the DC Cohort study - a multicentre prospective cohort study of HIV-infected outpatients - we assessed the period prevalence of metabolic comorbidities between 2011 and 2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results. RESULTS Of 7018 adult patients (median age 50 years; 77% black), 50% [95% confidence interval (CI) 49-51] had hypertension, 13% (95% CI: 12-14) had diabetes, 48% (95% CI: 47-49) had dyslipidaemia, and 35% (95% CI: 34-36) had obesity. Hypertension was more prevalent among black patients, diabetes and obesity were more prevalent among female and black patients, dyslipidaemia was more prevalent among male and white patients, and comorbidities were more prevalent among older patients (all P < 0.001). For many patients, evidence of treatment for these comorbidities was not available in the EMR. Longer time since HIV diagnosis, greater duration of antiretroviral treatment, and having controlled immunovirological parameters were associated with metabolic comorbidities. CONCLUSIONS These findings underscore the pervasive burden of metabolic comorbidities among HIV-infected persons, serve as the basis for future analyses characterizing their impact on subsequent adverse cardiovascular outcomes, and highlight the need for an increased focus on the prevention and control of comorbid complications in this population.
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Affiliation(s)
- M E Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - A E Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - R Hart
- Research Department, Cerner Corporation, Kansas City, MO, USA
| | - L Powers Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - C Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - A Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
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Womack J, Murphy T, Bathulapalli H, Akgün K, Gibert C, Kunisaki K, Rodriguez-Barradas M, Yaggi HK, Justice A, Redeker N. Trajectories of Sleep Disturbance Severity in HIV-Infected and Uninfected Veterans. J Assoc Nurses AIDS Care 2017; 28:431-437. [PMID: 28389058 PMCID: PMC5442598 DOI: 10.1016/j.jana.2017.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Julie Womack
- Associate Professor, Yale School of Nursing, and a Health Research Specialist at the VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Terrence Murphy
- Assistant Professor, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Kathleen Akgün
- Assistant Professor, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cynthia Gibert
- Professor, Department of Medicine, School of Medicine and Health Sciences at The George Washington University, and physician, Veterans Affairs Medical Center, Washington, DC, USA
| | - Kenneth Kunisaki
- Associate Professor, University of Minnesota, and Medical Director, Minneapolis VA Sleep Apnea Clinic, Minneapolis, Minnesota, USA
| | - Maria Rodriguez-Barradas
- Professor of Medicine/Infectious Disease, Baylor College of Medicine, and Chief, Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - H. Klar Yaggi
- Associate Professor of Medicine and Director of Yale Centers for Sleep Medicine, New Haven, Connecticut, USA, and Staff Physician at VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Amy Justice
- Professor of Medicine and of Public Health, Yale Schools of Medicine and Public Health, New Haven, Connecticut, USA
| | - Nancy Redeker
- Beatrice Renfield Term Professor of Nursing, Yale School of Nursing, West Haven, Connecticut, USA
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Martínez-Salazar MF, Oaxaca-Navarro J, Leija-Salas A, García-Jiménez S, Sánchez-Alemán MA, Déciga-Campos M. Analysis of self-reported adverse reactions to efavirenz and drug interactions in a population with HIV in Mexico. Eur J Hosp Pharm 2017; 25:322-326. [PMID: 31157050 DOI: 10.1136/ejhpharm-2016-001106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/04/2017] [Accepted: 01/16/2017] [Indexed: 12/14/2022] Open
Abstract
Objective To analyse the most frequent self-reported adverse reactions (ARs), the durability and the causes of antiretrovirals (ARVs) regimens change, concomitant treatments and drug interactions related to the use of ARVs in a group of people living with HIV in Cuernavaca, Morelos, Mexico. Materials and methods Cross-sectional study conducted in a clinic specialising in HIV 'CAPASITS-Cuernavaca' in Mexico from February to June 2015. People who wanted to participate were given a questionnaire on demographic characteristics, adherence, concomitant treatments and ARs. To understand the clinical variables, the clinical records were reviewed. Quantitative variables were compared using Student's t-test for normal data and the Mann-Whitney U test for non-normal data. For comparisons between categorical variables, the χ2 test was used. All tests used a significance level of 0.05. Results A total of 96 people participated, and 218 ARs (mean= 2.3±1.9) were found. The most frequently encountered ARs were dizziness (53.1%), insomnia (21.9%) and lucid dreams (17.7%). Twenty-three people (24%) were polymedicated, and 18 potential interactions were detected in 12 people. Conclusions The results suggest that a thorough analysis of the possible drug interactions should be performed for polymedicated people on ARV treatment and that a protocol should be designed for the monitoring and management of AR to ensure a good adherence to ARV treatment.
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Affiliation(s)
- María Fernanda Martínez-Salazar
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | - Jesús Oaxaca-Navarro
- CAPASITS Cuernavaca, Servicios de Salud del Estado de Morelos, Cuernavaca, Morelos, México
| | - Alfonso Leija-Salas
- Facultad de Farmacia, Universidad Autónoma del Estado de Morelos Cuernavaca, Morelos, México
| | - Sara García-Jiménez
- Facultad de Farmacia, Universidad Autónoma del Estado de Morelos Cuernavaca, Morelos, México
| | - Miguel Angel Sánchez-Alemán
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Myrna Déciga-Campos
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
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Meyers J, Gajria K, Candrilli SD, Fridman M, Sikirica V. The impact of adjunctive guanfacine extended release on stimulant adherence in children/adolescents with attention-deficit/hyperactivity disorder. J Comp Eff Res 2017; 6:109-125. [DOI: 10.2217/cer-2016-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Aim: To assess stimulant adherence among children/adolescents with attention-deficit/hyperactivity disorder (ADHD) augmenting stimulants with guanfacine extended-release (GXR). Patients & methods: Inclusion criteria: 6–17 years, ≥1 ADHD diagnosis, ≥1 long-acting and/or short-acting stimulant with GXR augmentation. Modified medication possession ratio (mMPR; days medication available/days in period, excluding medication holidays) was assessed; mMPR <0.80 nonadherent. Regression models assessed change in mMPR adjusting for demographic and clinical characteristics. Results: Among patients nonadherent to stimulants pre-augmentation (n = 165), unadjusted mean (SD) pre- and post-stimulant mMPRs were 0.68 (0.11) and 0.87 (0.16). Adjusted mean change in mMPR was 0.20 for long-acting versus 0.18 for short-acting stimulants (p = 0.34). Conclusion: Among patients nonadherent to stimulants, GXR augmentation was associated with increased stimulant adherence.
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Affiliation(s)
- Juliana Meyers
- RTI Health Solutions, 3040 Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709, USA
| | - Kavita Gajria
- Shire, 725 Chesterbrook Boulevard, Wayne, PA 19087, USA
| | - Sean D Candrilli
- RTI Health Solutions, 3040 Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709, USA
| | - Moshe Fridman
- AMF Consulting, 846 S Citrus Avenue, Los Angeles, CA 90036, USA
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Webel AR, Perazzo J, Decker M, Horvat-Davey C, Sattar A, Voss J. Physical activity is associated with reduced fatigue in adults living with HIV/AIDS. J Adv Nurs 2016; 72:3104-3112. [PMID: 27485463 PMCID: PMC5118117 DOI: 10.1111/jan.13084] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 01/09/2023]
Abstract
AIMS The aim of this study was to describe the relationships among home-based physical activity, fatigue, sleep, gender and quality of life in people living with HIV/AIDS BACKGROUND: Fatigue is a common and distressing symptom among people living with HIV/AIDS. Few interventions exist that effectively reduce fatigue in this population. Physical activity has shown promise to reduce fatigue in other populations, but its impact on fatigue in HIV/AIDS has not yet been explored. DESIGN This study was conducted using a prospective, descriptive cohort design. METHODS Overall, 90 adults living with HIV/AIDS completed cross-sectional measures. Home-based physical activity was measured using a 7-day self-report diary. Fatigue was measured using the self-reported HIV-Related Fatigue Scale. Sleep was assessed using wrist actigraphy and quality of life was assessed using the HIV-Associated Quality of Life Scale. Data were collected from December 2012-April 2013 and analysed using correlations and multiple linear regression. RESULTS The number of minutes of home-based physical activity was significantly associated with reduced fatigue among people living with HIV/AIDS. In addition, increased fatigue was associated with decreased quality of life. No associations were found among fatigue, sleep or gender. CONCLUSIONS Our study demonstrates that physical activity in the home setting is an effective strategy to reduce fatigue among people living with HIV/AIDS. Future work developing and testing interventions to improve home-based physical activity in this population is needed.
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Affiliation(s)
- Allison R. Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106-4904, USA, 012163683939, , Twitter: @allisonwebelPhD
| | - Joe Perazzo
- Frances Payne Bolton School of Nursing, Case Western Reserve University
| | - Michael Decker
- Frances Payne Bolton School of Nursing, Case Western Reserve University
| | | | - Abdus Sattar
- School of Medicine, Case Western Reserve University
| | - Joachim Voss
- Sarah Cole Hirsh Center for Evidence-Based Practice, Frances Payne Bolton School of Nursing, Case Western Reserve University
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Santos WMD, Secoli SR, Padoin SMDM. Potential drug interactions in patients given antiretroviral therapy. Rev Lat Am Enfermagem 2016; 24:e2832. [PMID: 27878224 PMCID: PMC5173305 DOI: 10.1590/1518-8345.1193.2832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 08/14/2016] [Indexed: 01/25/2023] Open
Abstract
Objective to investigate potential drug-drug interactions (PDDI) in patients with HIV infection on antiretroviral therapy. Methods a cross-sectional study was conducted on 161 adults with HIV infection. Clinical, socio demographic, and antiretroviral treatment data were collected. To analyze the potential drug interactions, we used the software Micromedex(r). Statistical analysis was performed by binary logistic regression, with a p-value of ≤0.05 considered statistically significant. Results of the participants, 52.2% were exposed to potential drug-drug interactions. In total, there were 218 potential drug-drug interactions, of which 79.8% occurred between drugs used for antiretroviral therapy. There was an association between the use of five or more medications and potential drug-drug interactions (p = 0.000) and between the time period of antiretroviral therapy being over six years and potential drug-drug interactions (p < 0.00). The clinical impact was prevalent sedation and cardiotoxicity. Conclusions the PDDI identified in this study of moderate and higher severity are events that not only affect the therapeutic response leading to toxicity in the central nervous and cardiovascular systems, but also can interfere in tests used for detection of HIV resistance to antiretroviral drugs.
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Affiliation(s)
| | - Silvia Regina Secoli
- PhD, Associate Professor, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Stela Maris de Mello Padoin
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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132
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Sangarlangkarn A, Appelbaum JS. Caring for Older Adults with the Human Immunodeficiency Virus. J Am Geriatr Soc 2016; 64:2322-2329. [PMID: 27682476 DOI: 10.1111/jgs.14584] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Increasing proportions of older adults are living with the human immunodeficiency virus (HIV). It is estimated that more than 50% of individuals with HIV in the United States are aged 50 and older. Part of this group consists of individuals who have aged with chronic HIV infection, but a large proportion also results from new HIV diagnosis, with approximately 17% of new HIV diagnoses in 2013 occurring in individuals aged 50 and older. Although many of the recommendations on management of HIV infection are not age-specific, individuals with HIV aged 50 and older differ from their younger counterparts in many aspects, including immune response to antiretroviral therapy, multimorbidity, antiretroviral toxicities, and diagnostic considerations. This article outline these differences, offers a strategy on how to care for this unique population, and provides special considerations for problem-based management of individuals with HIV aged 50 and older.
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Affiliation(s)
- Aroonsiri Sangarlangkarn
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Jonathan S Appelbaum
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida
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Gimeno-Gracia M, Crusells-Canales MJ, Armesto-Gómez FJ, Compaired-Turlán V, Rabanaque-Hernández MJ. Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population. Clin Interv Aging 2016; 11:1149-57. [PMID: 27616883 PMCID: PMC5008447 DOI: 10.2147/cia.s108072] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background The percentage of older HIV-positive patients is growing, with an increase in age-related comorbidities and concomitant medication. Objectives To 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. Methods HIV-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. Results Polypharmacy 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). Conclusion Polypharmacy 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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Affiliation(s)
- Mercedes Gimeno-Gracia
- Pharmacy Department, Lozano Blesa University Clinical Hospital, Aragon Institute for Health Research
| | - María José Crusells-Canales
- Department of Infectious Diseases, Aragon Institute for Health Research, Lozano Blesa University Clinical Hospital
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Rasmussen LD, Kronborg G, Larsen CS, Pedersen C, Gerstoft J, Obel N, Pottegård A. Use of non-antiretroviral drugs among individuals with and without HIV-infection: a Danish nationwide study. Infect Dis (Lond) 2016; 49:42-54. [PMID: 27686116 DOI: 10.1080/23744235.2016.1212168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM We investigated the use of non-antiretroviral drugs in the HIV-infected compared to the general population. METHODS From the Danish HIV Cohort Study, we identified all HIV-infected individuals older than 18 years at HIV diagnosis who received care in Denmark through 1995-2013 and reported no injection drug abuse or hepatitis C infection. Population controls were identified from The Danish Civil Registration System and matched on age and gender (5:1). We analyzed the proportion of individuals who redeemed 0-1, 2-4, 5-9, or 10 or more non-antiretroviral drugs. Data were analyzed according to calendar time, age, time from initiation of combination antiretroviral therapy (cART) and stratified by gender, geographical origin and route of HIV transmission. We further analyzed the use of the 25 most used non-antiretroviral drug classes. RESULTS We identified 4,928 HIV-infected individuals (median age: 37; 76.4% males). Overall, the HIV-infected population had a higher use of non-antiretroviral drugs compared to the background population. Whereas, the use of non-antiretroviral drugs in the HIV-infected population only changed marginally with time, the use in the background population increased considerably. Thus, use in the HIV-infected population only differed marginally from that of the background population in recent years. This difference was most pronounced in men who have sex with men (MSM). CONCLUSION Compared to the background population, HIV infected individuals have increased use of non-antiretroviral drugs. The excess use is mainly observed in MSM and has decreased with calendar time, why it in recent years only differs marginally from that observed in the background population.
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Affiliation(s)
- Line D Rasmussen
- a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark
| | - Gitte Kronborg
- b Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark
| | - Carsten S Larsen
- c Department of Infectious Diseases , Aarhus University Hospital , Skejby , Denmark
| | - Court Pedersen
- a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark
| | - Jan Gerstoft
- d Department of Infectious Diseases , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Niels Obel
- d Department of Infectious Diseases , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Anton Pottegård
- e Clinical Pharmacology, Department of Public Health , University of Southern Denmark , Odense , Denmark
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135
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HIV Infection in the Elderly: Arising Challenges. J Aging Res 2016; 2016:2404857. [PMID: 27595022 PMCID: PMC4993911 DOI: 10.1155/2016/2404857] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/14/2016] [Accepted: 06/30/2016] [Indexed: 12/27/2022] Open
Abstract
Globally there is an increase in the number of people living with HIV at an advanced age (50 years and above). This is mainly due to prolonged survival following the use of highly active antiretroviral therapy. Living with HIV at an advanced age has been shown to be associated with a number of challenges, both clinical and immunological. This minireview aims at discussing the challenges encountered by elderly HIV-infected patients.
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Sharma A, Hoover DR, Shi Q, Holman S, Plankey MW, Wheeler AL, Weber K, Floris-Moore M, Bolivar HH, Vance DE, Mack WJ, Golub ET, Holstad MM, Yin MT. Falls among middle-aged women in the Women's Interagency HIV Study. Antivir Ther 2016; 21:697-706. [PMID: 27427794 PMCID: PMC5243157 DOI: 10.3851/imp3070] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND To determine the frequency and risk factors for falls among middle-aged HIV+ and HIV- women in the Women's Interagency HIV Study (WIHS). METHODS We quantified self-report of any and multiple (≥2) falls in the prior 6 months among 1,412 HIV+ and 650 HIV- women with mean age 48 years. Logistic regression was used to evaluate associations of demographics, behavioural factors, comorbid conditions and medications with odds of any fall (versus none) and multiple falls (versus ≤1 fall). RESULTS At least one fall was reported in 263 HIV+ (19%) versus 119 HIV- (18%) women, and ≥2 falls reported in 133 HIV+ (9%) versus 65 HIV- (10%) women. HIV infection was not associated with falls in multivariate analyses. Factors independently associated with any fall included age (adjusted odds ratio [aOR] 1.71, 95% CI 1.17, 2.49 age 50-59 versus <39 years; aOR 2.26, 95% CI 1.38, 3.71 age ≥60 versus <39), current marijuana use (aOR 2.19, 95% CI 1.53, 3.13) depressive symptoms (aOR 1.57, 95% CI 1.21, 2.05 for Center for Epidemiology Studies Depression score ≥16), subjective cognitive complaints (aOR 2.19, 95% CI 1.56, 3.08), neuropathy (aOR 1.59, 95% CI 1.19, 2.13), obesity (aOR 1.39, 95% CI 1.08, 1.80), number of central nervous system active agents (aOR 2.98, 95% CI 1.90, 4.68 for ≥3 agents versus 0) and WIHS site. Factors associated with ≥2 falls included age, marijuana use, number of central nervous system active agents, subjective cognitive complaints, depressive symptoms, neuropathy and study site. CONCLUSIONS Falls were associated with factors affecting cognition, but not HIV status in this large cohort of women. Longitudinal studies are needed to determine the incidence and consequences of falls by HIV status as women age.
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Affiliation(s)
- Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, Piscataway, NJ, USA
| | - Qiuhu Shi
- Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY, USA
| | - Susan Holman
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Amber L Wheeler
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Kathleen Weber
- Department of Medicine, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Hector H Bolivar
- Department of Medicine, University of Miami Health System, Miami, FL, USA
| | - David E Vance
- School of Nursing, the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wendy J Mack
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Michael T Yin
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
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137
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Montes-Escalante I, Monje-Agudo P, Calvo-Cidoncha E, Almeida-González CV, Morillo-Verdugo R. Design and validation of a predictive model for 1-year hospital admission in HIV patients on antiretroviral treatment. Eur J Hosp Pharm 2016; 23:224-227. [PMID: 31156853 DOI: 10.1136/ejhpharm-2015-000788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/20/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022] Open
Abstract
Objectives To develop and validate a model for predicting the risk of hospital admission within 1 year in the HIV population under antiretroviral treatment. Methods We conducted a retrospective observational study. Patients receiving antiretroviral treatment for at least 1 year who were followed by the pharmacy service in a Spanish-speaking hospital between January 2008 and December 2012 were included. Demographics, and clinical and pharmacotherapy variables, were included in the model design. To find prognostic factors for hospital admission a multivariate logistic regression model was created after performing a univariate analysis. Model validity was determined by the shrinkage method and the model discrimination by Harrell's C-index. Results 442 patients were included in the study. The variables 'CD4 count <200 (cells/µL)', 'drug/alcohol use', 'detectable viral load (>50 copies/mL)', 'number of previous admissions', and 'number of drugs different from antiretroviral treatment' were the independent predictors of risk of hospital admission. Probabilities predicted by the model showed an R2=0.98 for the development sample and an R2=0.86 for the validation sample. The Harrell's C index for the development and validation data were 0.82 (95% CI 0.77 to 0.87) and 0.80 (95% CI 0.73 to 0.88), respectively. Conclusions The model developed in this study may be useful in daily practice for identifying HIV patients at high risk of 1-year hospital admission.
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138
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Tetrault JM, Tate JP, Edelman EJ, Gordon AJ, Lo Re V, Lim JK, Rimland D, Goulet J, Crystal S, Gaither JR, Gibert CL, Rodriguez-Barradas MC, Fiellin LE, Bryant K, Justice AC, Fiellin DA. Hepatic Safety of Buprenorphine in HIV-Infected and Uninfected Patients With Opioid Use Disorder: The Role of HCV-Infection. J Subst Abuse Treat 2016; 68:62-7. [PMID: 27431048 DOI: 10.1016/j.jsat.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 05/10/2016] [Accepted: 06/03/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Individuals with HIV and hepatitis C (HCV) infection, alcohol use disorder, or who are prescribed potentially hepatotoxic medications may be at increased risk for buprenorphine (BUP) associated hepatotoxicity. MATERIALS AND METHODS We examined a cohort of HIV-infected and uninfected patients receiving an initial BUP prescription between 2003 and 2012. We compared changes in alanine and aspartate aminotransferases (ALT and AST) and total bilirubin (TB) stratified by HIV status. We identified cases of liver enzyme elevation (LEE), TB elevation (TBE), and conducted chart review to assess for cases of drug induced liver injury (DILI) and death. We examined associations between age, sex, race, HIV-infection, HCV-infection, alcohol use disorder, and prescription of other potentially heptatotoxic medications with the composite endpoint of LEE, TBE, and DILI. RESULTS Of 666 patients prescribed BUP, 36% were HIV-infected, 98% were male, 60% had RNA-confirmed HCV infection, 50% had a recent diagnosis of alcohol use disorder, and 64% were prescribed other potentially hepatotoxic medications. No clinically significant changes were observed in median ALT, AST and TB and these changes did not differ between HIV-infected and uninfected patients. Compared with uninfected patients, HIV-infected (OR 7.3, 95% CI 2.1-26.1, p=0.002), HCV-infected (OR 4.9 95% CI 1.6-15.2, p=0.007) or HIV/HCV co-infected patients (OR 6.9, 95%CI 2.1-22.2, p=0.001) were more likely to have the composite endpoint of LEE, TB elevation or DILI, in analyses that excluded 60 patients with evidence of pre-existing liver injury. 31 patients had LEE, 14/187 HIV-infected and 17/340 uninfected (p=0.25); 11 had TBE, including 9/186 HIV-infected and 2/329 uninfected (p=0.002); 8 experienced DILI, 4/202 HIV-infected and 4/204 uninfected (p=0.45). There were no significant associations with alcohol use disorder or prescription of other potentially hepatotoxic medications after adjustment for HIV/HCV status. CONCLUSIONS Liver enzymes and TB are rarely elevated in HIV-infected and uninfected patients receiving BUP. Risk of hepatotoxicity was greater in individuals infected with HIV, HCV, or HIV/HCV co-infection, who may benefit from increased monitoring.
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Affiliation(s)
- Jeanette M Tetrault
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
| | - Janet P Tate
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; VA Connecticut Health Care System, West Haven, CT
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Adam J Gordon
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA
| | - Vincent Lo Re
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Joseph K Lim
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - David Rimland
- VA Medical Center, Atlanta, GA; Emory University School of Medicine, Atlanta, GA
| | - Joseph Goulet
- VA Connecticut Health Care System, West Haven, CT; Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University
| | - Julie R Gaither
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT
| | - Cynthia L Gibert
- VA Medical Center Washington DC; George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Lynn E Fiellin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Kendall Bryant
- National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD
| | - Amy C Justice
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; VA Connecticut Health Care System, West Haven, CT; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT
| | - David A Fiellin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT
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139
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Serrano-Villar S, Gutiérrez F, Miralles C, Berenguer J, Rivero A, Martínez E, Moreno S. Human Immunodeficiency Virus as a Chronic Disease: Evaluation and Management of Nonacquired Immune Deficiency Syndrome-Defining Conditions. Open Forum Infect Dis 2016; 3:ofw097. [PMID: 27419169 PMCID: PMC4943534 DOI: 10.1093/ofid/ofw097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/29/2016] [Indexed: 12/17/2022] Open
Abstract
In the modern antiretroviral therapy (ART) era, motivated people living with human immunodeficiency virus (HIV) who have access to therapy are expected to maintain viral suppression indefinitely and to receive treatment for decades. Hence, the current clinical scenario has dramatically shifted since the early 1980s, from treatment and prevention of opportunistic infections and palliative care to a new scenario in which most HIV specialists focus on HIV primary care, ie, the follow up of stable patients, surveillance of long-term toxicities, and screening and prevention of age-related conditions. The median age of HIV-infected adults on ART is progressively increasing. By 2030, 3 of every 4 patients are expected to be aged 50 years or older in many countries, more than 80% will have at least 1 age-related disease, and approximately one third will have at least 3 age-related diseases. Contemporary care of HIV-infected patients is evolving, and questions about how we might monitor and perhaps even treat HIV-infected adults have emerged. Through key published works, this review briefly describes the most prevalent comorbidities and age-associated conditions and highlights the differential features in the HIV-infected population. We also discuss the most critical aspects to be considered in the care of patients with HIV for the management and prevention of age-associated disease.
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Affiliation(s)
- Sergio Serrano-Villar
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria and Universidad de Alcalá , Madrid
| | - Félix Gutiérrez
- Hospital Universitario de Elche and Universidad Miguel Hernández , Alicante
| | | | - Juan Berenguer
- Juan Berenguer , Hospital Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón , Madrid
| | - Antonio Rivero
- Unidad de Gestión Clínica Enfermedades Infecciosas , Hospital Universitario Reina Sofía and Instituto Maimónides de Investigación Biomédica de Córdoba
| | - Esteban Martínez
- Hospital Clínic and Instituto de Investigaciones Biomédicas August Pi i Sunyer, University of Barcelona , Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria and Universidad de Alcalá , Madrid
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140
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Merlin JS, Tamhane A, Starrels JL, Kertesz S, Saag M, Cropsey K. Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV. AIDS Behav 2016; 20:687-98. [PMID: 26487298 DOI: 10.1007/s10461-015-1178-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Opioids are often prescribed for chronic pain, and opioid risks such as overdose and death are heightened when opioids are co-prescribed with other sedating medications. We investigated factors associated with chronic opioid prescription, alone and in combination with benzodiazepines and muscle relaxants, in a clinical cohort of individuals with HIV. We used multivariable logistic regression models to determine participant clinical and demographic characteristics that are associated with chronic prescription of opioids or chronic co-prescription of opioids with sedating medications. Among 1474 participants, chronic prescription of opioids occurred in 253 individuals (17.2 %), and chronic co-prescription occurred in 90 individuals (6.1 %). Age >50, public insurance as compared to private insurance, and symptoms of depression and anxiety were significantly associated with chronic opioid prescription and chronic co-prescription. Our findings raise concern that opioid prescription and co-prescription of sedating medications occurs disproportionately in patients for whom use is riskier.
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Affiliation(s)
- Jessica S Merlin
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, BBRB 222, 1530 3rd Ave S, Birmingham, AL, 35294-2170, USA.
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Ashutosh Tamhane
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, BBRB 222, 1530 3rd Ave S, Birmingham, AL, 35294-2170, USA
| | - Joanna L Starrels
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stefan Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael Saag
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, BBRB 222, 1530 3rd Ave S, Birmingham, AL, 35294-2170, USA
| | - Karen Cropsey
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
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141
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Becker WC, Gordon K, Edelman EJ, Kerns RD, Crystal S, Dziura JD, Fiellin LE, Gordon AJ, Goulet JL, Justice AC, Fiellin DA. Trends in Any and High-Dose Opioid Analgesic Receipt Among Aging Patients With and Without HIV. AIDS Behav 2016; 20:679-86. [PMID: 26384973 PMCID: PMC5006945 DOI: 10.1007/s10461-015-1197-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Harms of opioid analgesics, especially high-dose therapy among individuals with comorbidities and older age, are increasingly recognized. However, trends in opioid receipt among HIV-infected patients are not well characterized. We examined trends, from 1999 to 2010, in any and high-dose (≥120 mg/day) opioid receipt among patients with and without HIV, by age strata, controlling for demographic and clinical correlates. Of 127,216 patients, 64 % received at least one opioid prescription. Opioid receipt increased substantially among HIV-infected and uninfected patients over the study; high-dose therapy was more prevalent among HIV-infected patients. Trends in high-dose receipt stratified by three age groups revealed an increasing trend in each age strata, higher among HIV-infected patients. Correlates of any opioid receipt included HIV, PTSD and major depression. Correlates of high-dose receipt included HIV, PTSD, major depression and drug use disorders. These findings suggest a need for appropriate balance of risks and benefits, especially as these populations age.
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Affiliation(s)
- William C Becker
- Internal Medicine, West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Kirsha Gordon
- Internal Medicine, West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - E Jennifer Edelman
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Robert D Kerns
- Psychology, VA Connecticut Healthcare System, West Haven, CT, USA
- Psychology, Yale University School of Medicine, New Haven, CT, USA
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - James D Dziura
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lynn E Fiellin
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Adam J Gordon
- University of Pittsburgh and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Joseph L Goulet
- Psychology, VA Connecticut Healthcare System, West Haven, CT, USA
- Psychology, Yale University School of Medicine, New Haven, CT, USA
| | - Amy C Justice
- Internal Medicine, West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - David A Fiellin
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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142
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Monteiro F, Canavarro MC, Pereira M. Factors associated with quality of life in middle-aged and older patients living with HIV. AIDS Care 2016; 28 Suppl 1:92-8. [PMID: 26881294 PMCID: PMC4828599 DOI: 10.1080/09540121.2016.1146209] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
HIV infection has been historically considered a disease of young adults; however, adults aged 50 years and older represent now an increasing proportion of HIV cases worldwide, including in Portugal. In this context, given the considerable burden associated with living with HIV, the topic of quality-of-life (QoL) assessment has become increasingly relevant. The aims of this study were to examine the age-related differences in QoL and depressive symptoms of younger and middle-aged and older adults with HIV as well as the sociodemographic, HIV-related and depressive symptoms (cognitive-affective and somatic) associated with QoL domains. The sample consisted of 1194 HIV-infected patients, recruited from 10 Portuguese hospitals. QoL data were collected using the WHOQOL-HIV-Bref questionnaire. Patients also completed the Beck Depression Inventory. Of the 1194 patients, 185 (15.5%) were over 50 years old. Middle-aged and older patients reported significantly lower QoL in the physical, independence and social relationships domains. Regarding the specific facets of QoL, middle-aged and older patients reported significantly lower scores in seven of the 29 specific facets of the WHOQOL-HIV-Bref and higher scores in one facet (financial resources). Overall, among middle-aged and older patients, higher education, being employed, a shorter time since HIV diagnosis, use of combination anti-retroviral therapy and fewer depressive symptoms were significantly associated with higher QoL ratings. Our findings suggest that both cognitive-affective and somatic depressive symptoms account for significant variability in QoL scores in middle-aged and older patients. Because an important feature of healthy ageing is maintaining QoL, these data may provide useful information for tailoring age-appropriate and effective interventions to improve the mental health and QoL of middle-aged and older patients living with HIV.
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Affiliation(s)
- Fabiana Monteiro
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | | | - Marco Pereira
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
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143
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Kowalska JD, Kubicka J, Siwak E, Pulik P, Firląg-Burkacka E, Horban A. Factors associated with the first antiretroviral therapy modification in older HIV-1 positive patients. AIDS Res Ther 2016; 13:2. [PMID: 26744599 PMCID: PMC4704295 DOI: 10.1186/s12981-015-0084-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 11/30/2015] [Indexed: 01/09/2023] Open
Abstract
Background Rates of first antiretroviral therapy (cART) modifications are high in most observational studies. The age-related differences in treatment duration and characteristics of first cART modifications remain underinvestigated. With increasing proportion of older patients in HIV population it is important to better understand age-related treatment effects. Methods Patients were included into this analysis, if being cART naïve at the first visit at the clinic. Follow-up time was measured from the first visit date until first cART modification or 28 February 2013. First cART modification was defined as any change in the third drug component i.e. protease inhibitor (PI), non-nucleoside reverse transcriptase inhibitor (NNRTI), integrase inhibitor or fusion inhibitor. Cox proportional hazard models were used to identify factors related to first cART modification in three age groups: <30, 30–50 and >50. Results In total 2027 patients with 14,965 person-years of follow-up (PYFU) were included. The oldest group included 136 patients with 1901, middle group 1202 with 8416 PYFU and youngest group consisted of 689 patients with 4648 PYFU. Median follow-up time was 5.8 (IQR 3.4–9.4) years, median time on first cART was 4.4 (IQR 2.1–8.5) years. 72.4 % of patients started PI-based and 26.1 % NNRTI-based regimen. In total 1268 (62.5 %) patients had cART modification (non-adherence 30.8 %, toxicity 29.6 %). Durability of first cART was the best in patients over 50 y.o. (log-rank test, p = 0.001). Factors associated with discontinuation in this group were late presentation (HR 0.45, [95 % CI 0.23–0.90], p = 0.02) and PI use (HR 2.17, [95 % CI 1.18–4.0], p = 0.01). Conclusions Rates of first cART modifications or discontinuation were comparable in all groups; however older patients were significantly longer on first cART regimen.
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144
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Krentz HB, Gill MJ. The Impact of Non-Antiretroviral Polypharmacy on the Continuity of Antiretroviral Therapy (ART) Among HIV Patients. AIDS Patient Care STDS 2016; 30:11-7. [PMID: 26544766 DOI: 10.1089/apc.2015.0199] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Improved survival achieved by many patients with HIV/AIDS has complicated their medical care as increasing numbers of co-morbidities leads to polypharmacy, increased pill burdens, and greater risks of drug-drug interactions potentially compromising antiretroviral treatment (ART). We examined the impact of non-antiretroviral polypharmacy on ART for all adults followed at the Southern Alberta Clinic, Calgary, Canada. Polypharmacy was defined as ≥5 daily medications. We compared the impact of polypharmacy on continuous (i.e., remaining on same ART for ≥6 months) vs. non-continuous (i.e., discontinuing or switching ART) ART dosing frequency, number of ART pills, number of non-ART medications, and age. Of 1190 (89.5%) patients on ART, 95% were on three-drug regimens, 63.9% on QD ART, and 62% ≥3 ART pills daily; 32.2% were experiencing polypharmacy. Polypharmacy was associated with lower CD4, AIDS, >180 months living with HIV, higher numbers of ART pills, and older age (all p < 0.01); 32.1% stopped or switched ART. Polypharmacy increased the risk for non-continuous ART (36.8% vs. 30.0%; p < 0.01). Non-continuous ART increased with daily ART pill count but not increased age. Non-adherence and adverse effects accounted for the majority of non-continuous ART. We found a strong association between polypharmacy and non-continuous ART, potentially leading to effective ART being compromised. Collaborative approaches are needed to anticipate the negative impacts of polypharmacy.
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Affiliation(s)
- Hartmut B Krentz
- 1 Southern Alberta Clinic , Calgary, Alberta, Canada
- 2 Department of Medicine, University of Calgary , Calgary, Alberta, Canada
| | - M John Gill
- 1 Southern Alberta Clinic , Calgary, Alberta, Canada
- 2 Department of Medicine, University of Calgary , Calgary, Alberta, Canada
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Harris CM, McKenzie R, Nayak S, Kiyatkin D, Baker D, Kisuule F. Graying of the HIV epidemic: a challenge for inpatient medicine providers. J Community Hosp Intern Med Perspect 2015; 5:29428. [PMID: 26653693 PMCID: PMC4677594 DOI: 10.3402/jchimp.v5.29428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 12/25/2022] Open
Abstract
Since the advent of anti-retroviral therapy, patients with HIV are living longer, and in the year 2015, over half of those infected with the virus will be older than age 50. Moreover, as the general aging population continues to grow, more elderly individuals will become newly infected with HIV. Older patients with HIV contribute to high numbers of initial and rehospitalizations, have longer lengths of hospital day stays, and are at increased risk of death compared to younger patients with HIV and those without HIV. Age-related comorbidities can be exaggerated in HIV-positive patients on and off therapy. Furthermore, signs and symptoms of HIV and AIDS may mimic features seen in the normal aging process of older adults. Internists caring for patients in inpatient settings will be expected to care for and diagnose increasing numbers of older patients with HIV. This will be critical for improving quality of patient care, reducing morbidity and mortality, and managing newly diagnosed patients earlier in the disease course while reducing spread of the virus. Internists should be central leaders in the development of targeted and non-targeted HIV screening efforts in inpatient general medicine wards.
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Affiliation(s)
- Ché Matthew Harris
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.,Divisions of Hospital Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA;
| | - Robin McKenzie
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.,Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Seema Nayak
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.,Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Dmitry Kiyatkin
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.,Divisions of Hospital Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Dorcas Baker
- Community Public Health Nursing, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Flora Kisuule
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.,Divisions of Hospital Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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146
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Moore HN, Mao L, Oramasionwu CU. Factors associated with polypharmacy and the prescription of multiple medications among persons living with HIV (PLWH) compared to non-PLWH. AIDS Care 2015; 27:1443-8. [PMID: 26608408 DOI: 10.1080/09540121.2015.1109583] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Persons living with HIV (PLWH) may be at increased risk for polypharmacy (≥5 concomitant medications) over non-PLWH, presumably due to antiretroviral therapy (ARV). Potential concerns associated with polypharmacy include clinically significant drug-drug interactions, adverse drug reactions, increased pill burden, and rising treatment-related costs. Our objective was to evaluate prescription of multiple non-ARV medications to PLWH, compared to non-PLWH, in US outpatient clinics and to identify factors associated with polypharmacy. Cross-sectional data from the 2006-2010 National Hospital Ambulatory Medical Care Survey were used for this study. Visits for PLWH were identified using HIV ICD9-CM codes 042, V08, and 079.53. Patients < 18 years of age were excluded. Relevant demographics included sex, age, race/ethnicity, and insurance status, while comorbid conditions included hypertension, diabetes, and hyperlipidemia. Multivariate logistic regression analyses evaluated factors independently associated with prescription of ≥ 5 medications. In total, 7,360,000 weighted visits for PLWH (13% aged 18-29 y; 55% aged 30-49 y; 32% aged ≥ 50 y) and 374,626,000 weighted visits for non-PLWH (18% aged 18-29 y; 32% aged 30-49 y; 50% aged ≥ 50 y) met study criteria. The greatest prevalence of hypertension, diabetes, and hyperlipidemia was in those ≥ 50 years of age (p < .001 for all comorbidities in PLWH and non-PLWH). In 2006, 16% of PLWH were prescribed ≥ 5 medications, doubling to 35% in 2010. In 2006, 24% of non-PLWH were prescribed ≥ 5 medications, only increasing to 32% in 2010. Older age (30-49 y and ≥ 50 y) was associated with ≥ 5 prescription medications in PLWH (adjusted odds ratio [aOR] = 2.538, 95% CI; 1.31-4.918 and aOR = 2.703, 95% CI; 1.678-4.354) and in non-PLWH (aOR = 2.546, 95% CI; 2.235-2.9 and aOR = 5.208, 95% CI; 4.486-6.047), respectively. Prescription of multiple medications is on the rise in PLWH, more so than in non-PLWH. Additional research is needed to explore how prescription of multiple medications differentially affects younger PLWH vs. older PLWH.
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Affiliation(s)
- Heather N Moore
- a UNC Eshelman School of Pharmacy, University of North Carolina , Chapel Hill , NC , USA
| | - Lu Mao
- b Department of Biostatistics , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA
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Injection Drug Use and Hepatitis C as Risk Factors for Mortality in HIV-Infected Individuals: The Antiretroviral Therapy Cohort Collaboration. J Acquir Immune Defic Syndr 2015; 69:348-54. [PMID: 25848927 DOI: 10.1097/qai.0000000000000603] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND HIV-infected individuals with a history of transmission through injection drug use (IDU) have poorer survival than other risk groups. The extent to which higher rates of hepatitis C (HCV) infection in IDU explain survival differences is unclear. METHODS Adults who started antiretroviral therapy between 2000 and 2009 in 16 European and North American cohorts with >70% complete data on HCV status were followed for 3 years. We estimated unadjusted and adjusted (for age, sex, baseline CD4 count and HIV-1 RNA, AIDS diagnosis before antiretroviral therapy, and stratified by cohort) mortality hazard ratios for IDU (versus non-IDU) and for HCV-infected (versus HCV uninfected). RESULTS Of 32,703 patients, 3374 (10%) were IDU; 4630 (14%) were HCV+; 1116 (3.4%) died. Mortality was higher in IDU compared with non-IDU [adjusted HR 2.71; 95% confidence interval (CI): 2.32 to 3.16] and in HCV+ compared with HCV- (adjusted HR 2.65; 95% CI: 2.31 to 3.04). The effect of IDU was substantially attenuated (adjusted HR 1.57; 95% CI: 1.27 to 1.94) after adjustment for HCV, while attenuation of the effect of HCV was less substantial (adjusted HR 2.04; 95% CI: 1.68 to 2.47) after adjustment for IDU. Both IDU and HCV were strongly associated with liver-related mortality (adjusted HR 10.89; 95% CI: 6.47 to 18.3 for IDU and adjusted HR 14.0; 95% CI: 8.05 to 24.5 for HCV) with greater attenuation of the effect of IDU (adjusted HR 2.43; 95% CI: 1.24 to 4.78) than for HCV (adjusted HR 7.97; 95% CI: 3.83 to 16.6). Rates of CNS, respiratory and violent deaths remained elevated in IDU after adjustment for HCV. CONCLUSIONS A substantial proportion of the excess mortality in HIV-infected IDU is explained by HCV coinfection. These findings underscore the potential impact on mortality of new treatments for HCV in HIV-infected people.
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148
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Abstract
BACKGROUND Geriatric syndromes such as falls, frailty, and functional impairment are multifactorial conditions used to identify vulnerable older adults. Limited data exist on these conditions in older HIV-infected adults, and no studies have comprehensively examined these conditions. METHODS Geriatric syndromes including falls, urinary incontinence, functional impairment, frailty, sensory impairment, depression, and cognitive impairment were measured in a cross-sectional study of HIV-infected adults aged 50 years and older who had an undetectable viral load on antiretroviral therapy. We examined both HIV and non-HIV-related predictors of geriatric syndromes including sociodemographics, number of comorbidities and nonantiretroviral medications, and HIV-specific variables in multivariate analyses. RESULTS We studied 155 participants with a median age of 57 (interquartile range: 54-62) and 94% were men. Prefrailty (56%), difficulty with instrumental activities of daily living (46%), and cognitive impairment (47%) were the most frequent geriatric syndromes. Lower CD4 nadir incidence rate ratio [IRR: 1.16, 95% (confidence interval) CI: 1.06 to 1.26], non-white race (IRR: 1.38, 95% CI: 1.10 to 1.74), and increasing number of comorbidities (IRR: 1.09, 95% CI: 1.03 to 1.15) were associated with increased risk of having more geriatric syndromes. CONCLUSIONS Geriatric syndromes are common in older HIV-infected adults. Treatment of comorbidities and early initiation of antiretroviral therapy may help to prevent development of these age-related complications. Clinical care of older HIV-infected adults should consider incorporation of geriatric principles.
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149
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Implementation of latent tuberculosis screening in HIV care centres: evaluation in a low tuberculosis incidence setting. Epidemiol Infect 2015. [PMID: 26211466 DOI: 10.1017/s0950268815001594] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The screening and treatment of latent tuberculosis infection (LTBI) to prevent active tuberculosis (TB) is recommended by the WHO in all HIV-infected patients. The aim of this study was to evaluate its implementation within Belgium's HIV care. A multiple-choice questionnaire was sent to 55 physicians working in the country's AIDS reference centres. Response rate reached 62%. Only 20% screened all their HIV-infected patients for LTBI. Screening methods used and their interpretation vary from one physician to another. The main barriers to the implementation of LTBI screening and treatment, as perceived by the participants, are lack of sensitivity of screening tools, risks associated with polypharmacy and toxicity of treatment. The poor coverage of LTBI screening reported here and the inconsistency in methods used raises concern. However, this was not unexpected as, in low-TB incidence countries, who, when and how to screen for LTBI remains unclear and published guidelines show important disparities. Recently, a targeted approach in which only HIV-infected patients at highest risk of TB are screened has been suggested. Such a strategy would limit unnecessary exposure to LTBI treatment. This methodology was approved by 80% of the participants and could therefore achieve greater coverage. Its clinical validation is still pending.
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150
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Weisberg DF, Gordon KS, Barry DT, Becker WC, Crystal S, Edelman EJ, Gaither J, Gordon AJ, Goulet J, Kerns RD, Moore BA, Tate J, Justice AC, Fiellin DA. Long-term Prescription of Opioids and/or Benzodiazepines and Mortality Among HIV-Infected and Uninfected Patients. J Acquir Immune Defic Syndr 2015; 69:223-33. [PMID: 26009831 PMCID: PMC4446730 DOI: 10.1097/qai.0000000000000591] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Increased long-term prescription of opioids and/or benzodiazepines necessitates evaluating risks associated with their receipt. We sought to evaluate the association between long-term opioids and/or benzodiazepines and mortality in HIV-infected patients receiving antiretroviral therapy and uninfected patients. METHODS Prospective analysis of all-cause mortality using multivariable methods and propensity score matching among HIV-infected patients receiving antiretroviral therapy and uninfected patients. RESULTS Of 64,602 available patients (16,989 HIV-infected and 47,613 uninfected), 27,128 (exposed and unexposed to long-term opioids and/or benzodiazepines) were 1:1 matched by propensity score. The hazard ratio for death was 1.40 [95% confidence interval (CI): 1.22 to 1.61] for long-term opioid receipt, 1.26 (95% CI: 1.08 to 1.48) for long-term benzodiazepine receipt, and 1.56 (95% CI: 1.26 to 1.92) for long-term opioid and benzodiazepine receipt. There was an interaction (P = 0.01) between long-term opioid receipt and HIV status with mortality. For long-term opioid receipt, the hazard ratio was 1.46 (95% CI: 1.15 to 1.87) among HIV-infected patients, and 1.25 (95% CI: 1.05 to 1.49) among uninfected patients. Mortality risk was increased for patients receiving both long-term opioids and benzodiazepines when opioid doses were ≥ 20 mg morphine-equivalent daily dose and for patients receiving long-term opioids alone when doses were ≥ 50 mg morphine-equivalent daily dose. CONCLUSIONS Long-term opioid receipt was associated with an increased risk of death; especially with long-term benzodiazepine receipt, higher opioid doses, and among HIV-infected patients. Long-term benzodiazepine receipt was associated with an increased risk of death regardless of opioid receipt. Strategies to mitigate risks associated with these medications, and caution when they are coprescribed, are needed particularly in HIV-infected populations.
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Affiliation(s)
- Daniel F Weisberg
- *Yale University School of Medicine, New Haven, CT; †VA Connecticut Healthcare System, West Haven, CT; Departments of ‡Psychiatry; §Internal Medicine, Yale University School of Medicine, New Haven, CT; ‖Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ; ¶Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT; #Yale University School of Public Health, New Haven, CT; **Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; ††VA Pittsburgh Healthcare System, Pittsburgh, PA; and ‡‡Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
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