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Linfield RY, Nguyen NN, Laprade OH, Holodniy M, Chary A. An update on drug-drug interactions in older adults living with human immunodeficiency virus (HIV). Expert Rev Clin Pharmacol 2024; 17:589-614. [PMID: 38753455 PMCID: PMC11233252 DOI: 10.1080/17512433.2024.2350968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION People with HIV are living longer due to advances in antiretroviral therapy. With improved life expectancy comes an increased lifetime risk of comorbid conditions - such as cardiovascular disease and cancer - and polypharmacy. Older adults, particularly those living with HIV, are more vulnerable to drug interactions and adverse effects, resulting in negative health outcomes. AREA COVERED Antiretrovirals are involved in many potential drug interactions with medications used to treat common comorbidities and geriatric conditions in an aging population of people with HIV. We review the mechanisms and management of significant drug-drug interactions involving antiretroviral medications and non-antiretroviral medications commonly used among older people living with HIV. The management of these interactions may require dose adjustments, medication switches to alternatives, enhanced monitoring, and considerations of patient- and disease-specific factors. EXPERT OPINION Clinicians managing comorbid conditions among older people with HIV must be particularly vigilant to side effect profiles, drug-drug interactions, pill burden, and cost when optimizing treatment. To support healthier aging among people living with HIV, there is a growing need for antiretroviral stewardship, multidisciplinary care models, and advances that promote insight into the correlations between an individual, their conditions, and their medications.
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Affiliation(s)
| | - Nancy N. Nguyen
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Olivia H. Laprade
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Mark Holodniy
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
| | - Aarthi Chary
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
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Fernández-Fradejas J, Delgado-Silveira E, González-Burgos E, Álvarez-Díaz AM, Vélez-Díaz-Pallarés M. Potentially inappropriate prescriptions and potential prescription omissions in older people living with HIV. HIV Med 2024; 25:587-599. [PMID: 38258538 DOI: 10.1111/hiv.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES This study aimed to determine the prevalence of potentially inappropriate prescriptions (PIPs) and potential prescription omissions (PPOs) in a Spanish cohort of people living with HIV (PLWH) aged ≥65 years and to identify risk factors for the presence of PIPs and PPOs. METHODS This retrospective cross-sectional study was conducted across 10 public hospitals in the Autonomous Community of Madrid, Spain. Clinical and demographic data were cross-checked against hospital and community pharmacy dispensation registries. PIPs and PPOs were assessed using the American Geriatrics Society (AGS)/Beers and Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria. Risk factors for PIPs and PPOs and agreement between AGS/Beers and STOPP/START criteria were statistically analysed. RESULTS This study included 313 PLWH (median age 72 years), of whom 80.5% were men. PIP prevalence rates were 29.4% and 44.4% based on the AGS/Beers and STOPP criteria, respectively. The concordance between AGS/Beers and STOPP criteria was moderate. Benzodiazepines and proton pump inhibitors were the chronic comedications most commonly involved in PIPs. PPOs were observed in 61.4% of the patients. The leading omissions were insufficient influenza and pneumococcal vaccine coverage and inadequate bone health-related treatments. The number of chronic comedications, female sex, neuropsychiatric disorders, and cancer diagnosis were risk factors for PIPs, whereas osteopenia and osteoporosis were risk factors for PPOs. CONCLUSIONS A high prevalence of PIPs and PPOs was observed in our cohort of older PLWH. These findings emphasize the importance of comprehensive medication reviews in this population to reduce inappropriate medication use and address their specific and underserved therapeutic needs.
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Affiliation(s)
- Jorge Fernández-Fradejas
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Eva Delgado-Silveira
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Elena González-Burgos
- Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Ana María Álvarez-Díaz
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Manuel Vélez-Díaz-Pallarés
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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Tetart M, Passecountrin P, Lesourd A, Sanderink D, Le Moal G, Surgers L, Beraud G, Katlama C, Robineau O, Parienti JJ. Are unknown co-medications, over-the-counter and off-label drug use still problems among people living with HIV? Results from a transversal survey in 23 centres in France. J Antimicrob Chemother 2023; 78:2731-2734. [PMID: 37757452 DOI: 10.1093/jac/dkad292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Polypharmacy can lead to drug-drug interactions (DDIs), especially with ART. The burden of co-medications, including over-the-counter (OTC) drugs and self-medications, could be underestimated. We aimed to investigate the proportion of people living with HIV (PLHIV) with declared and undeclared co-medications, as well as their potential burden. METHODS We conducted a national, multicentre, 1 week cross-sectional study between 10 December and 16 December 2019 in 23 French hospitals amongst consecutive adult PLHIV presenting for a routine outpatient visit. A standardized questionnaire filled in by the physicians assessed all medications and other active chemical substances taken by the PLHIV. RESULTS Overall we enrolled 496 participants from 23 centres. Median age was 50.6 years; ART regimens included an integrase inhibitor in 61% (n = 302), an NNRTI in 34% (n = 169) and a PI in 14% (n = 70) of the cases. Co-medications involved 392 (79%) PLHIV, among which 85 (17%) received polypharmacy (≥5 medications). Previously unknown co-medications or other active substances were found for 32% (n = 159) of the participants. Corticosteroids (9%, n = 46) and proton pump inhibitors (10%, n = 50) were frequently administered. These co-medications did not differ according to age range. Illegal drug use was declared by 11% (n = 54) and OTC drugs by 23% (n = 113) of PLHIV. Potential DDIs were discovered for 11% (n = 53), leading to treatment modifications in 47% (25/53) of cases. CONCLUSIONS Potential DDIs that lead to therapeutic modifications remain significant whatever the age of PLHIV. More devoted time to identify co-medications and OTC treatment is needed in all PLHIV.
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Affiliation(s)
- Macha Tetart
- Service Universitaire des Maladies Infectieuses et du Voyageur, Tourcoing, Hauts de France, France
| | - Priscila Passecountrin
- Service des Maladies Infectieuses et Tropicales, La Pitié Salpêtrière, APHP, Paris, Ile de France, France
| | - Anaïs Lesourd
- Service des Maladies Infectieuses et Tropicales, CHU Rouen, Rouen, Seine Maritime, France
| | - Diane Sanderink
- Service des Maladies Infectieuses, CHU Angers, Angers, Maine-et-Loire, France
| | - Gwenaël Le Moal
- Service des Maladies Infectieuses, CHU Poitiers, Poitiers, Vienne, France
| | - Laure Surgers
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012 Paris, Ile de France, France
- GHU APHP.Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, F75012 Paris, Ile de France, France
| | - Guillaume Beraud
- Service des Maladies Infectieuses et Tropicales, CHU Rouen, Rouen, Seine Maritime, France
| | - Christine Katlama
- Service des Maladies Infectieuses et Tropicales, La Pitié Salpêtrière, APHP, Paris, Ile de France, France
| | - Olivier Robineau
- Service Universitaire des Maladies Infectieuses et du Voyageur, Tourcoing, Hauts de France, France
- Service des Maladies Infectieuses et Tropicales, La Pitié Salpêtrière, APHP, Paris, Ile de France, France
- Service des Maladies Infectieuses et Tropicales, CHU Rouen, Rouen, Seine Maritime, France
- Service des Maladies Infectieuses, CHU Angers, Angers, Maine-et-Loire, France
- Service des Maladies Infectieuses, CHU Poitiers, Poitiers, Vienne, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012 Paris, Ile de France, France
- GHU APHP.Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, F75012 Paris, Ile de France, France
- EA2694, Université Lille, Centre Hospitalier de Tourcoing, Tourcoing, Hauts de France, France
| | - Jean-Jacques Parienti
- Service des Maladies Infectieuses et Tropicales, CHU Caen, Caen, Calvados, France
- INSERM U1311 DYNAMICURE, Caen Normandy University, Caen, Calvados, France
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İNKAYA AÇ, BALLI FN, KARA E, DEMİRKAN K, ÜNAL S. A retrospective study: Can dual ART mitigate the risk of potential drug-drug interactions among PLWH under stable ART? Turk J Med Sci 2023; 53:1505-1511. [PMID: 38813033 PMCID: PMC10763791 DOI: 10.55730/1300-0144.5718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 10/26/2023] [Accepted: 09/17/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim People living with human immunodeficiency virus (PLWH) are getting older. Age-related comorbidities in PLWH result in polypharmacy and increase the risk for potential drug-drug interactions (pDDIs). This study aimed to evaluate how the rate of pDDIs would change if the treatment of patients receiving different combined antiretroviral therapies (ARTs) were theoretically changed with dolutegravir/lamivudine (DTG+3TC) or cabotegravir/rilpivirine (CAB+RPV). Materials and methods This study was conducted at the infectious disease outpatient clinic of a university hospital as a follow-up of a previous study. The data of PLWH receiving at least 1 comedication other than antiretrovirals (ARVs) were retrospectively reviewed and analyzed. The Drugs.com/Drug Interactions Checker and University of Liverpool HIV Drug Interactions Checker databases were used to identify pDDIs and their severities. Results A total of 75 PLWH, of whom 83% were male, with a mean age (± standard deviation) of 46.5 (±12.98) years were included. Polypharmacy was observed in 59 (79%) of the participants; however, with dual ARV options, the probability of polypharmacy was 35 (47%) (p < 0.001). In the Drugs.com database, no significant difference was found in terms of pDDIs between the treatment of current ARTs (64%) and DTG/3TC (%44) (p = 0.06) or CAB/RPV (%64) (p = 0.521). However, in the University of Liverpool database, the current rate of pDDIs (55%) was significantly higher compared to the theoretical treatment of DTG/3TC (40%) (p = 0.029), oral CAB/RPV (48%) (p = 0.003), and injectable CAB/RPV (31%) use (p = 0.006). Conclusion The results suggest that dual treatment regimens can reduce pDDIs, resulting in better tolerance and probably higher quality of life among PLWH.
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Affiliation(s)
- Ahmet Çağkan İNKAYA
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Fatma Nisa BALLI
- Department of Clinical Pharmacy, Faculty of Pharmacy, Gazi University, Ankara,
Turkiye
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara,
Turkiye
| | - Emre KARA
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara,
Turkiye
| | - Kutay DEMİRKAN
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara,
Turkiye
| | - Serhat ÜNAL
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
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Jamieson H, Nishtala P, Bergler HU, Weaver S, Pickering J, Ailabouni N, Abey-Nesbit R, Gullery C, Deely J, Gee S, Hilmer S, Mangin D. Deprescribing Anticholinergic and Sedative Drugs to Reduce Polypharmacy in Frail Older Adults Living in the Community: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2023; 78:1692-1700. [PMID: 36692224 PMCID: PMC10460556 DOI: 10.1093/gerona/glac249] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Polypharmacy is associated with poor outcomes in older adults. Targeted deprescribing of anticholinergic and sedative medications may improve health outcomes for frail older adults. Our pharmacist-led deprescribing intervention was a pragmatic 2-arm randomized controlled trial stratified by frailty. We compared usual care (control) with the intervention of pharmacists providing deprescribing recommendations to general practitioners. METHODS Community-based older adults (≥65 years) from 2 New Zealand district health boards were recruited following a standardized interRAI needs assessment. The Drug Burden Index (DBI) was used to quantify the use of sedative and anticholinergic medications for each participant. The trial was stratified into low, medium, and high-frailty. We hypothesized that the intervention would increase the proportion of participants with a reduction in DBI ≥ 0.5 within 6 months. RESULTS Of 363 participants, 21 (12.7%) in the control group and 21 (12.2%) in the intervention group had a reduction in DBI ≥ 0.5. The difference in the proportion of -0.4% (95% confidence interval [CI]: -7.9% to 7.0%) provided no evidence of efficacy for the intervention. Similarly, there was no evidence to suggest the effectiveness of this intervention for participants of any frailty level. CONCLUSION Our pharmacist-led medication review of frail older participants did not reduce the anticholinergic/sedative load within 6 months. Coronavirus disease 2019 (COVID-19) lockdown measures required modification of the intervention. Subgroup analyses pre- and post-lockdown showed no impact on outcomes. Reviewing this and other deprescribing trials through the lens of implementation science may aid an understanding of the contextual determinants preventing or enabling successful deprescribing implementation strategies.
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Affiliation(s)
- Hamish Jamieson
- Department of Medicine, Burwood Hospital, University of Otago, Christchurch, New Zealand
| | - Prasad S Nishtala
- Department of Pharmacy and Pharmacology, Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Hans Ulrich Bergler
- Department of Medicine, Burwood Hospital, University of Otago, Christchurch, New Zealand
| | - Susan K Weaver
- Department of Medicine, Burwood Hospital, University of Otago, Christchurch, New Zealand
| | - John W Pickering
- Department of Medicine, Burwood Hospital, University of Otago, Christchurch, New Zealand
| | - Nagham J Ailabouni
- The Pharmacy Australian Centre of Excellence (PACE), School of Pharmacy, University of Queensland, Brisbane, Queensland, South Australia, Australia
- UniSA Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Rebecca Abey-Nesbit
- Department of Medicine, Burwood Hospital, University of Otago, Christchurch, New Zealand
| | - Carolyn Gullery
- Planning, Funding and Decision Support, Canterbury District Health Board, General Manager of Planning, Funding and Decision Support; Lightfoot Solutions, Healthcare Systems, Specialist Advisor, Berkshire, UK
| | - Joanne Deely
- Burwood Academy Trust, Christchurch, New Zealand
| | - Susan B Gee
- Psychiatry of Old Age Academic Unit, Canterbury District Health Board, Christchurch, New Zealand
| | - Sarah N Hilmer
- Geriatric Pharmacology, Faculty of Medicine and Health, Northern Clinical School, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Dee Mangin
- Primary Care Research Group, University of Otago, Christchurch, New Zealand
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Gandhi RT, Bedimo R, Hoy JF, Landovitz RJ, Smith DM, Eaton EF, Lehmann C, Springer SA, Sax PE, Thompson MA, Benson CA, Buchbinder SP, Del Rio C, Eron JJ, Günthard HF, Molina JM, Jacobsen DM, Saag MS. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society-USA Panel. JAMA 2023; 329:63-84. [PMID: 36454551 DOI: 10.1001/jama.2022.22246] [Citation(s) in RCA: 161] [Impact Index Per Article: 161.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Importance Recent advances in treatment and prevention of HIV warrant updated recommendations to guide optimal practice. Objective Based on a critical evaluation of new data, to provide clinicians with recommendations on use of antiretroviral drugs for the treatment and prevention of HIV, laboratory monitoring, care of people aging with HIV, substance use disorder and HIV, and new challenges in people with HIV, including COVID-19 and monkeypox virus infection. Evidence Review A panel of volunteer expert physician scientists were appointed to update the 2020 consensus recommendations. Relevant evidence in the literature (PubMed and Embase searches, which initially yielded 7891 unique citations, of which 834 were considered relevant) and studies presented at peer-reviewed scientific conferences between January 2020 and October 2022 were considered. Findings Initiation of antiretroviral therapy (ART) is recommended as soon as possible after diagnosis of HIV. Barriers to care should be addressed, including ensuring access to ART and adherence support. Integrase strand transfer inhibitor-containing regimens remain the mainstay of initial therapy. For people who have achieved viral suppression with a daily oral regimen, long-acting injectable therapy with cabotegravir plus rilpivirine given as infrequently as every 2 months is now an option. Weight gain and metabolic complications have been linked to certain antiretroviral medications; novel strategies to ameliorate these complications are needed. Management of comorbidities throughout the life span is increasingly important, because people with HIV are living longer and confronting the health challenges of aging. In addition, management of substance use disorder in people with HIV requires an evidence-based, integrated approach. Options for preexposure prophylaxis include oral medications (tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine) and, for the first time, a long-acting injectable agent, cabotegravir. Recent global health emergencies, like the SARS-CoV-2 pandemic and monkeypox virus outbreak, continue to have a major effect on people with HIV and the delivery of services. To address these and other challenges, an equity-based approach is essential. Conclusions and Relevance Advances in treatment and prevention of HIV continue to improve outcomes, but challenges and opportunities remain.
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Affiliation(s)
- Rajesh T Gandhi
- Massachusetts General Hospital and Harvard Medical School, Boston
| | - Roger Bedimo
- University of Texas Southwestern Medical Center, Dallas
| | - Jennifer F Hoy
- The Alfred Hospital and Monash University, Melbourne, Australia
| | | | - Davey M Smith
- University of California San Diego School of Medicine
| | | | - Clara Lehmann
- University of Cologne and German Center for Infection Research (DZIF), Bonn-Cologne
| | - Sandra A Springer
- Yale University School of Medicine, New Haven, Connecticut
- The Veterans Administration Connecticut Healthcare System, West Haven
| | - Paul E Sax
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Carlos Del Rio
- Emory University School of Medicine and Grady Health System, Atlanta, Georgia
| | - Joseph J Eron
- The University of North Carolina School of Medicine at Chapel Hill
| | - Huldrych F Günthard
- University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jean-Michel Molina
- University of Paris Cité, Saint-Louis and Lariboisière Hospitals, Assistance Publique Hopitaux de Paris, France
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Bristow C, Barber T. Managing frailty in people with human immunodeficiency virus. Br J Hosp Med (Lond) 2022; 83:1-7. [DOI: 10.12968/hmed.2021.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The population of people living with human immunodeficiency virus (HIV) is ageing and has an increasing burden of non-acquired immune deficiency syndrome (AIDS)-related morbidity and mortality, including frailty. Frailty is prevalent at a younger age in this population and is associated with multimorbidity, disability and death. This article examines the key interventions to ameliorate the advancement of frailty in people living with HIV. It explores methods of successfully delivering a multidisciplinary holistic approach to this complex patient group, using three case studies. The most effective frailty intervention is exercise. Group-based physiotherapy classes protect against functional decline and frailty symptomatology. Optimisation of medical and psychiatric comorbidities, including deprescribing when appropriate, is also essential. Addressing the social determinants of frailty, such as social isolation and loneliness, are beneficial, but are dependent on local charities and resources. More research is required to assess pharmacological and nutritional interventions in frailty. This requires a greater understanding of the exact pathophysiology of frailty, which remains poorly understood.
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Affiliation(s)
- Clare Bristow
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Tristan Barber
- Institute for Global Health, University College London, London, UK
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8
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Díaz-Acedo R, Soriano-Martinez M, Gutiérrez-Pizarraya A, Fernandez-Gonzalez-Caballos JA, Raya-Siles M, Morillo-Verdugo R. Prevalence of PIMDINAC criteria and associated factors in elderly HIV patients. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:258-261. [PMID: 35248518 DOI: 10.1016/j.eimce.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Aging of people living with HIV could be related to potentially inappropiate medication prescriptions, drugs interactions and lack of drugs adherence. PIMDINAC criteria seek to jointly analyze these problems. The objective of this study is to determine the prevalence of PIMDINAC criteria in an elderly HIV population. METHODS Observational, cross-sectional, multicenter study that included patients older than 65 years in pharmacotherapeutic follow-up between February-April 2020. The main endpoint was the percentage of PIMDINAC criteria identified in the study population. RESULTS Forty-seven patientes were included, identifying total PIMDINAC in 12.5%. Non-adherence to concomitant treatment was detected in 65.6% of patients, potentially inappropiate medication in 48.9% and drugs interactions in 25.2%. The number of concomitant drugs and polypharmacy were associated with a higher appearance of PIMDINAC criteria. CONCLUSION The prevalence of PIMDINAC criteria in elderly HIV patients is high.
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Affiliation(s)
- Rocío Díaz-Acedo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain.
| | | | | | | | | | - Ramón Morillo-Verdugo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
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9
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Blanco JR, Gallardo J. Mind the polypharmacy in people living with HIV. A new challenge for the fourth 90. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Blanco JR, Gallardo J. Mind the polypharmacy in people living with HIV. A new challenge for the fourth 90. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:5-6. [PMID: 34991853 DOI: 10.1016/j.eimce.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Affiliation(s)
- José R Blanco
- Servicio de Enfermedades Infecciosas. Hospital Universitario San Pedro. Logroño; Centro de Investigación Biomédica de La Rioja.
| | - Jara Gallardo
- Servicio de Farmacia Hospitalaria. Hospital Universitario San Pedro. Logroño
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Smith L, Letendre S, Erlandson KM, Ma Q, Ellis RJ, Farhadian SF. Polypharmacy in older adults with HIV infection: Effects on the brain. J Am Geriatr Soc 2021; 70:924-927. [PMID: 34855982 PMCID: PMC8904273 DOI: 10.1111/jgs.17569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/07/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Lauren Smith
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Scott Letendre
- Department of Infectious Diseases, University of California San Diego School of Medicine, San Diego, California, USA
| | - Kristine M Erlandson
- Department of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Qing Ma
- School of Pharmacy & Pharmaceutical Sciences, University of Buffalo, Buffalo, New York, USA
| | - Ronald J Ellis
- Departments of Neurosciences and Psychiatry, University of California San Diego School of Medicine, San Diego, California, USA
| | - Shelli F Farhadian
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
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Gaurang N, Priyadharsini R, Balamurugesan K, Prakash M, Reka D. Attitudes and beliefs of patients and primary caregivers towards deprescribing in a tertiary health care facility. Pharm Pract (Granada) 2021; 19:2350. [PMID: 34621447 PMCID: PMC8455127 DOI: 10.18549/pharmpract.2021.3.2350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background Good prescribing practices form the essence of drug therapy for better patient care. The major aim of better prescribing is to improve rational prescribing. Deprescribing gained momentum in recent decades. Objective This study aimed to explore the attitude and beliefs of deprescribing among patients and their caregivers forming dyads in a tertiary health care facility. Methods Cross-sectional, questionnaire-based prospective study done for two months. Attitude towards deprescribing was assessed by using validated rPATD (revised Patient attitude towards deprescribing) questionnaire. Cohen's kappa coefficient was used to measure the agreement between the views of people and their caregivers forming dyads about medication cessation. Results 312 patients and caregivers (156 forming dyads) participated in the study. Among 156 patients, 25.6% were hypertensives & 21.2% had diabetes. 41.7% were between 36-50 years of age. Only 16.7% belong to the elderly age group. 2.5% were taking >5 medications. 43.6% of patients and 62.2% of caregivers were female. 51.3% of the patients were willing to stop one or more of their regular medicine(s) under the treating physician's advice, but 62% were satisfied with their current medicine(s). 33.4% were reluctant to stop taking medicines for a long time. Conclusions In our study, more than 50% of people and their caregivers were willing to try medication cessation under their physician's recommendation. There was moderate agreement between patients and their caregivers in the trial of medication cessation. Thus, the results obtained from this study may help towards improving rationalized prescribing practices in the institutional setup.
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Affiliation(s)
- Narayan Gaurang
- MBBS. Indira Gandhi Medical College and Research Institute (IGMC&RI). Puducherry (India).
| | - Rajendran Priyadharsini
- Assistant Professor. Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Puducherry (India).
| | - Kandan Balamurugesan
- Additional Professor. Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Puducherry (India).
| | - Mathiyalagen Prakash
- Assistant Professor. Department of Community Medicine, Indira Gandhi Medical College and Research Institute (IGMC&RI). Puducherry (India).
| | - Devanathan Reka
- Junior resident. Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Puducherry (India).
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13
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Guaraldi G, Milic J, Marcotullio S, Mussini C. A patient-centred approach to deprescribing antiretroviral therapy in people living with HIV. J Antimicrob Chemother 2021; 75:3425-3432. [PMID: 32747939 DOI: 10.1093/jac/dkaa329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Only a few studies have explored the benefit of deprescribing in people living with HIV (PLWH), focusing on the discontinuation of non-antiretrovirals (non-ARVs) used for HIV-associated comorbidities (co-medications), or the management of drug-drug interactions (DDIs) between ARVs or between ARVs and co-medications. The availability of modern single-tablet regimens, two-drug regimens and long-acting therapy opens a discussion regarding ARV deprescribing strategies. The objective of this article is to discuss ARV deprescribing strategies in the context of medication-related burden and patients' lived experience with medicine (PLEM) and to suggest indications for whom, when, how and why to consider these ARV options in PLWH. A PLEM construct helps to better interpret these strategies and provides a patient-centred precision-medicine approach. There are several safe and virologically effective ARV deprescribing strategies, but the ultimate benefits of these interventions still need to be further explored in terms of the overall health and quality of life of patients.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy.,Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy.,Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Italy
| | | | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy.,Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Italy
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14
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Murray MM, Lin J, Buros Stein A, Wilcox ML, Cottreau J, Postelnick M, Palella FJ. Relationship of polypharmacy to HIV RNA suppression in people aged ≥ 50 years living with HIV. HIV Med 2021; 22:742-749. [PMID: 34077632 DOI: 10.1111/hiv.13122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/28/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) aged ≥ 50 years face unique challenges regarding their medication therapies, especially antiretroviral therapy (ART). Use of ARTs, along with medications for comorbidities, may lead to adverse events, drug-drug interactions (DDIs) and poor adherence. The objective of this study was to identify the number of medications above which PLWH aged ≥ 50 years are less likely to be virally suppressed and to describe other associated patient-specific risk factors. METHODS This was a cross-sectional study of PLWH aged ≥ 50 years, prescribed ART, and seen at least once in the Northwestern Infectious Disease Center between 1 June 2013 and 31 May 2015. Variables concerning medication use and comorbidities were collected. The primary outcome was the presence of an undetectable plasma HIV RNA level (viral load). RESULTS Among the 621 included patients, there was a higher percentage taking ≤ 15 medications with an undetectable plasma HIV RNA (n = 453; 80.6%) vs. patients taking > 15 medications (n = 40; 67.8%; P = 0.03). Taking > 15 medications [odds ratio (OR) 0.49; 95% confidence interval (CI) 0.26-0.96], pulmonary disease (OR 0.54; 95% CI 0.3-0.97) and CD4 T-lymphocyte count < 200 cells/μL (OR 0.39; 95% CI 0.22-0.68) decreased the odds of having an undetectable plasma HIV RNA. CONCLUSIONS PLWH taking > 15 medications were less likely to have an undetectable HIV RNA. Further studies are needed to evaluate the impact of overall medication economic burden on clinical outcomes among PLWH ≥ 50 years of age.
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Affiliation(s)
- M M Murray
- Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, IL, USA.,Northwestern Memorial Hospital, Chicago, IL, USA
| | - J Lin
- Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, IL, USA
| | - A Buros Stein
- Midwestern University, Office of Research and Sponsored Programs, Glendale, AZ, USA
| | - M L Wilcox
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - J Cottreau
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - M Postelnick
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - F J Palella
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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15
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Cantillana-Suárez MG, Robustillo-Cortés MDLA, Gutiérrez-Pizarraya A, Morillo-Verdugo R. Impact and acceptance of pharmacist-led interventions during HIV care in a third-level hospital in Spain using the Capacity-Motivation-Opportunity pharmaceutical care model: the IRAFE study. Eur J Hosp Pharm 2021; 28:e157-e163. [PMID: 33627478 DOI: 10.1136/ejhpharm-2020-002330] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/17/2020] [Accepted: 01/26/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In recent decades, HIV has become a chronic disease with which the HIV specialist pharmacist plays a fundamental role. The traditional pharmaceutical care model followed to date relied excessively on the medication, obviating the uniqueness of each patient. The purpose of this study was to determine the influence and acceptance of a Capacity-Motivation-Opportunity (CMO)-based structured pharmaceutical care (PC) intervention in a multidisciplinary team for improving healthcare results. METHODS Prospective single-centre study of a structured health intervention with patients living with HIV who attended hospital between January 2017 and June 2018 for any cause. Pharmacotherapeutic follow-up was applied according to the CMO PC model based on three key elements, namely stratification, motivational interview and new technologies. To assess differences in the variables collected before and after the intervention, Student's t-test or Wilcoxon test, and McNemar's test were used for quantitative and dichotomous variables, respectively. RESULTS A total of 349 patients were included, 76.1% of which were men. The acceptance of pharmacist intervention by both doctors and patients was high [336 (97.7%) and 321 (93.3%)] and the adherence rate to antiretroviral therapy before intervention was lower than that observed afterwards (85.6%±33.7% vs 96.4%±17.7%; p<0.001). No differences were found between median viral load pre- versus post-intervention [1175 (62.75-26 050) copies/mL vs 274 (76.75-5542) copies/mL], although the undetectability rate was recorded as higher after intervention compared with the previous period [294 (85.5%) vs 274 (79.7%); p<0.001]. CONCLUSIONS Our results could help HIV pharmacy clinic specialists to recognise high-risk patients and to develop personalised follow-up care, thereby ensuring good adherence and response to treatments.
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16
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Serrano Giménez R, Gallardo Anciano J, Robustillo Cortés MA, Blanco Ramos JR, Gutiérrez Pizarraya A, Morillo Verdugo R. Beliefs and attitudes about deprescription in older HIV-infected patients: ICARD Project. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2021; 34:18-27. [PMID: 33191724 PMCID: PMC7876903 DOI: 10.37201/req/084.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE HIV population is aging at an earlier age than those uninfected, requiring more non-HIV medications to treat noncommunicable diseases. In the context of chronic HIV infection, the next therapeutic change would be the polymedication control. This paper has the purpose of explore the attitudes of older people living with HIV toward deprescribing. METHODS This was an observational, prospective and multicenter study conducted from March-April, 2018. People living with HIV (PLWH) on highly active antiretroviral therapy and older than 65 years were included. In addition to demographic and pharmacotherapeutic data, attitudes regarding deprescribing were collected through the "Revised Patients' Attitudes Towards Deprescribing Questionnaire". RESULTS A total of 42 patients were included in this study. Regarding their attitudes in relation to deprescription, there were three statements with the most consensuses. The first ("I have a good understanding of the reasons I was prescribed each of my medicines") had 91.9% consensus. The second and third questions showed 89.2% consensus in both cases; "Overall, I am satisfied with my current medicines" and "I like to be involved in making decisions about my medicines with my doctors". CONCLUSIONS This study is the first to explore the beliefs and attitudes of older PLWH in relation to deprescription process. There are positive attitudes regarding medication knowledge but there also is a percentage of patients who had a negative opinion regarding deprescription. We must study and go deeper in our knowledge of techniques that could help us to better understand their preferences, in order to establish effective and successful deprescription strategies.
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Affiliation(s)
- R Serrano Giménez
- Reyes Serrano Giménez, Pharmacy Department, Valme University Hospital, Sevilla (Spain). Bellavista Avenue, no number. Postal Code: 41014.
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17
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Díaz-Acedo R, Soriano-Martinez M, Gutiérrez-Pizarraya A, Fernandez-Gonzalez-Caballos JA, Raya-Siles M, Morillo-Verdugo R. Prevalence of PIMDINAC criteria and associated factors in elderly HIV patients. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(20)30417-1. [PMID: 33451809 DOI: 10.1016/j.eimc.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Aging of people living with HIV could be related to potentially inappropriate medication prescriptions, drugs interactions and lack of drugs adherence. PIMDINAC criteria seek to jointly analyze these problems. The objective of this study is to determine the prevalence of PIMDINAC criteria in an elderly HIV population. METHODS Observational, cross-sectional, multicenter study that included patients older than 65 years in pharmacotherapeutic follow-up between February-April 2020. The main endpoint was the percentage of PIMDINAC criteria identified in the study population. RESULTS Forty-seven patientes were included, identifying total PIMDINAC in 12.5%. Non-adherence to concomitant treatment was detected in 65.6% of patients, potentially inappropriate medication in 48.9% and drugs interactions in 25.2%. The number of concomitant drugs and polypharmacy were associated with a higher appearance of PIMDINAC criteria. CONCLUSION The prevalence of PIMDINAC criteria in elderly HIV patients is high.
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Affiliation(s)
- Rocío Díaz-Acedo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España.
| | | | | | | | | | - Ramón Morillo-Verdugo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
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18
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Loste C, Moltó J, Pérez-Álvarez N, Puig J, Echeverría P, Bonjoch A, Fumaz CR, Lemos B, Estany C, Clotet B, Negredo E. Potential prescribing issues among older HIV-infected subjects in a Mediterranean cohort: Does the current prevalence give cause for concern? Br J Clin Pharmacol 2020; 87:1310-1317. [PMID: 32852102 DOI: 10.1111/bcp.14513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS To determine the prevalence of potential prescribing issues (PPI) in HIV-infected subjects aged ≥65 years according to the Beers and STOPP/START criteria and antiretroviral drug-drug interactions (Liverpool website). Secondary objectives were to assess the concordance between Beers and STOPP/START criteria in our population, and to identify the drugs most frequently involved in PPI. METHODS Cross-sectional cohort study based on a systematic review of the electronic drug prescriptions confirmed by an interview of 91 HIV-infected patients aged ≥65 years. Discrepancies between prescription criteria were assessed using crosstabs and compared using the χ2 test or Fisher exact test. RESULTS The mean age was 72.1 (5.6) years, 75.8% had ≥3 comorbidities and 59.3% polypharmacy. PPI were identified in 87.9%: 71.4% by STOPP/START and 45.1% by Beers. Comparing both criteria, 56.9% of PPI by STOPP/START were detected by Beers, while 92.5% of those detected by the Beers criteria were detected by STOPP/START (P < .001). Amber/red flag interactions between antiretrovirals and comedications were found in 45.1%: 3 severe (red) in 2 patients (2.2%). The most frequent drugs involved in PPI were benzodiazepines (>30%). Cobicistat was the drug most frequently involved in potential interactions (42.2%). CONCLUSION The prevalence of PPI among older HIV-infected persons gives cause for concern, as it is almost 90%. Optimization strategies, including a critical review of the treatment plan, should be implemented in clinical routine by a multidisciplinary team, in particular in patients with multiple comorbidities and polypharmacy. The STOPP/START criteria seem to detect more PPI, mainly for European populations.
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Affiliation(s)
- Cora Loste
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain.,Chair in Infectious Diseases and Immunity, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Spain
| | - José Moltó
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain
| | - Núria Pérez-Álvarez
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain.,Department of Statistics and Operations Research, Technical University of Catalonia-Barcelona Tech, Barcelona, Spain
| | - Jordi Puig
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain
| | - Patricia Echeverría
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain
| | - Anna Bonjoch
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain
| | - Carmina R Fumaz
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain
| | - Begoña Lemos
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain
| | - Carla Estany
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain
| | - Bonaventura Clotet
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain.,Chair in Infectious Diseases and Immunity, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Spain.,AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain
| | - Eugenia Negredo
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain.,Chair in Infectious Diseases and Immunity, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Spain
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19
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López-Centeno B, Badenes-Olmedo C, Mataix-Sanjuan A, Bellón JM, Pérez-Latorre L, López JC, Benedí J, Khoo S, Marzolini C, Calvo-Alcántara MJ, Berenguer J. Potentially inappropriate medications in older adults living with HIV. HIV Med 2020; 21:541-546. [PMID: 32516849 DOI: 10.1111/hiv.12883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We assessed the prevalence of potentially inappropriate medication (PIM) among older (≥ 65 years) people living with HIV (O-PLWH) in the region of Madrid. METHODS We analysed the dispensation registry of community and hospital pharmacies from the Madrid Regional Health Service (SERMAS) for the period between 1 January and 30 June 2017, looking specifically at PIMs according to the 2019 Beers criteria. Co-medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. RESULTS A total of 6 636 451 individuals received medications. Of these individuals, 22 945 received antiretrovirals (ARVs), and of these 1292 were O-PLWH. Overall, 1135 (87.8%) O-PLWH were taking at least one co-medication, and polypharmacy (at least five co-medications) was observed in 852 individuals (65.9%). A PIM was identified in 482 (37.3%) O-PLWH. Factors independently associated with PIM were polypharmacy [adjusted odds ratio (aOR) 7.08; 95% confidence interval (CI) 5.16-9.72] and female sex (aOR 1.75; 95% CI 1.30-2.35). The distribution of PIMs according to ATC drug class were nervous system drugs (n = 369; 28.6%), musculoskeletal system drugs (n = 140; 10.8%), gastrointestinal and metabolism drugs (n = 72; 5.6%), cardiovascular drugs (n = 61; 4.7%), respiratory system drugs (n = 13; 1.0%), antineoplastic and immunomodulating drugs (n = 10; 0.8%), and systemic anti-infectives (n = 2; 0.2%). Five drugs accounted for 84.8% of the 482O PLWH with PIMs: lorazepam (38.2%), ibuprofen (18.0%), diazepam (10.2%), metoclopramide (9.9%), and zolpidem (8.5%). CONCLUSIONS Prescription of PIMs is highly prevalent in O-PLWH. Consistent with data in uninfected elderly people, the most frequently observed PIMs were benzodiazepines and nonsteroidal anti-inflammatory drugs . Targeted interventions are warranted to reduce inappropriate prescribing and polypharmacy in this vulnerable population.
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Affiliation(s)
- B López-Centeno
- Directorate for Pharmacy and Health Products, Madrid Regional Health Service (SERMAS), Madrid, Spain
| | - C Badenes-Olmedo
- Ontology Engineering Group (OEG), School of Telecommunications and System Engineering, Polytechnic University of Madrid (UPM), Madrid, Spain
| | - A Mataix-Sanjuan
- Directorate for Pharmacy and Health Products, Madrid Regional Health Service (SERMAS), Madrid, Spain
| | - J M Bellón
- Gregorio Marañón General Hospital, Institute of Health Research Gregorio Marañón (IiSGM), Madrid, Spain
| | - L Pérez-Latorre
- Gregorio Marañón General Hospital, Institute of Health Research Gregorio Marañón (IiSGM), Madrid, Spain
| | - J C López
- Gregorio Marañón General Hospital, Institute of Health Research Gregorio Marañón (IiSGM), Madrid, Spain
| | - J Benedí
- Department of Pharmacology, Faculty of Pharmacy, Complutense Universtiy (UCM), Madrid, Spain
| | - S Khoo
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | - C Marzolini
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - M J Calvo-Alcántara
- Directorate for Pharmacy and Health Products, Madrid Regional Health Service (SERMAS), Madrid, Spain
| | - J Berenguer
- Gregorio Marañón General Hospital, Institute of Health Research Gregorio Marañón (IiSGM), Madrid, Spain
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