Evaluation of rates of virologic suppression in HIV-positive patients with varying numbers of comorbidities

Aging with HIV: The Burden of Comorbidities, Polypharmacy, and Drug Interactions in Korean People Living with HIV Aged ≥50 Years

BACKGROUND

The life expectancy of people living with human immunodeficiency virus (PLWH) has significantly improved with advancements in antiretroviral therapy (ART). However, aging PLWH face a growing burden of non-communicable diseases (NCDs), polypharmacy, and drug-drug interactions (DDIs), which pose challenges in their management. This study investigates the prevalence of NCDs, polypharmacy, and DDIs among PLWH aged ≥50 years in Korea and their impact on quality of life (QOL).

MATERIALS AND METHODS

A cross-sectional study was conducted among 243 PLWH aged ≥50 years receiving ART for at least three months at three university hospitals in Korea between January and July 2022. Data were collected through electronic medical records and personal interviews, assessing demographics, comorbidities, polypharmacy, ART adherence, and QOL using the Korean version of WHOQOL-HIV BREF scale. Potential DDIs were analyzed using the University of Liverpool HIV Drug Interaction Database, and potentially inappropriate medications (PIMs) were identified using the 2023 American Geriatrics Society Beers Criteria. We classified participants into three age groups: 50-<65 years, 65-<75 years, and ≥75 years.

RESULTS

The prevalence of comorbidities was 71.6%, with older participants (≥75 years) showing a significantly higher burden, including bone diseases, osteoarthritis, and dementia (P<0.001). Polypharmacy was observed in 28.4% of participants and increased with age, with 53.3% of those aged ≥75 years taking ≥10 pills daily. Polypharmacy was associated with poorer QOL (71.6 vs. 76.6, P=0.010). Amber-flag DDIs were found in 81 participants (33.3%), most commonly involving metformin and divalent cations. No red-flag DDIs were identified. PIMs were observed in 6.6% of participants aged ≥65 years.

CONCLUSION

Aging PLWH in Korea face significant challenges from comorbidities, polypharmacy, and DDIs, which negatively impact QOL. Integrated, age-specific, and multidisciplinary care strategies are urgently needed to improve outcomes and ensure the well-being of older PLWH.

Association Between Substance Abuse and Mental Illness Symptoms Screener (SAMISS) Scores and HIV Care Continuum Outcomes in People Newly Diagnosed with HIV in the US South

Mental illness (MI) and substance use (SU) are highly prevalent among people with HIV (PWH) and impact care outcomes. The Substance Abuse and Mental Illness Symptoms Screener (SAMISS) is a validated screener for MI and SU, but it is unknown how screening results at entry to care correlate with subsequent HIV outcomes. This is a retrospective chart review of individuals newly diagnosed with HIV between 2016 and 2019 in a Southern US, safety-net clinic. Baseline demographics, HIV risk factors, socioeconomic variables, and SAMISS screening scores were collected. Outcomes included retention in care, achieving virologic suppression (VS), and continuous VS. Data analyses included stepwise Cox and logistic multivariate regression modeling. Among the 544 newly diagnosed PWH, mean age was 35, 76% were male, 46% non-Hispanic Black, 40% Hispanic/other. Overall, 35% screened positive for SU and 41% for MI. A positive SU (odds ratio (OR) 0.66, p = 0.04) or MI (OR 0.65, p = 0.03) SAMISS screening was associated with lower retention in care in univariate analysis, but was not statistically significant after adjusting for other variables. Positive SAMISS screening for SU and MI were both associated with reduced continuous VS in univariate and multivariate analyses (SU: adjusted OR (aOR) 0.67, p = 0.05; MI: aOR 0.66, p = 0.03). SAMISS is a useful tool for prospectively identifying individuals at risk for low retention in care and for not achieving sustained VS. Future interventions guided by SAMISS may improve HIV care continuum outcomes.

HIV-hypertension treatment outcomes among adults on antiretroviral therapy in two states in Northern and Southern Nigeria: a cross-sectional design approach

Background

The combined effect of the aging human immunodeficiency virus (HIV) population, HIV's natural progression, and HIV drugs have great implications for comorbidity burden and hypertension control among people living with HIV (PLHIV).

Objectives

This study assessed hypertension burden, treatment outcomes, and treatment outcome predictors among PLHIV in Nigeria.

Design

Cross-sectional design.

Methods

A cross-sectional study of 2613 adult PLHIV who initiated antiretroviral therapy (ART) between 2004 and 2020 in two HIV clinics in Northern and Southern Nigeria. Study outcomes were: (1) controlled blood pressure defined as two consecutive blood pressure (BP) measurements of <140/90 mmHg (Joint National Committee guideline (JNC) 7) on the interview day in previously diagnosed hypertensive participants; and (2) HIV viral suppression defined as recent viral load count of <1000 copies/ml in a hypertensive participant. Data were analyzed using Statistical Package of Social Sciences IBM version 23. Univariate and multivariate logistic regression was done to ascertain factors associated with the study outcomes at p < 0.05.

Result

The mean age of respondents at the point of the study was 45.3 ± 9.8 years. Most of the participants were female, 1940 (74.2%), on a dolutegravir-based therapy, 2433 (93.2%). About 452 (17.3%) of the participants had clinically diagnosed hypertension. Of those diagnosed hypertensives, 443 (98.0%) were on antihypertensive drugs. About 407 (90.0%) and 229 (51.7%) of the hypertensive PLHIV had HIV viral suppression and controlled hypertension respectively. Factors associated with controlled hypertension were age at ART initiation (adjusted odds ratio (AOR): 0.96, 95% CI: 0.94-0.98), use of thiazide only antihypertensive (AOR: 1.91, 95% CI: 1.73-3.24, Ref: calcium channel blocker only) and thiazide-calcium channel blocker combination (AOR: 2.19, 95% CI: 1.05-4.58). No hypertension comorbidity-related factors were found to be associated with HIV viral suppression.

Conclusion

There is suboptimal hypertension control among hypertensive PLHIV especially those on non-thiazide-based antihypertensive drugs. Close monitoring should be given to hypertension management in PLHIV.

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

BACKGROUND

Older people living with HIV (PLWH) are at increased risks of co-morbidities and polypharmacy. However, little is known about factors affecting their needs and concerns about medicines. This systematic review aims to describe these and to identify interventions to improve medicine optimisation outcomes in older PLWH.

METHODS AND DATA SOURCES

Multiple databases and grey literature were searched from inception to February 2022 including MEDLINE, CINAHL, PsycInfo, PsychArticles, the Cochrane Database of Systematic Reviews and the Cochrane Controlled Register of Trials, Abstracts in Social Gerontology, and Academic Search Complete.

ELIGIBILITY CRITERIA

Studies reporting interventions/issues affecting older PLWH (sample populations with mean/median age ≥ 50 years; any aspect of medicine optimisation, or concerns). Quality assessments were completed by means of critical appraisal checklists for each study design. Title and abstract screening was led by one reviewer and a sample reviewed independently by two reviewers. Full-paper reviews were completed by one author and a 20% sample was reviewed independently by two reviewers.

SYNTHESIS

Data were extracted by three independent reviewers using standardised data extraction forms and synthesised according to outcomes or interventions reported. Data were summarised to include key themes, outcomes or concerns, and summary of intervention.

RESULTS

Seventy-nine (n = 79) studies met the eligibility criteria, most of which originated from the USA (n = 36). A few studies originated from Australia (n = 5), Canada (n = 5), Spain (n = 9), and the UK (n = 5). Ten studies originated from Sub-Saharan Africa (Kenya n = 1, South Africa n = 6, Tanzania n = 1, Uganda n = 1, Zimbabwe n = 1). The rest of the studies were from China (n = 1), France (n = 1), Germany (n = 1), Italy (n = 1), the Netherlands (n = 1), Pakistan (n = 1), Switzerland (n = 1), Saudi Arabia (n = 1) and Ukraine (n = 1). Publication dates ranged from 2002 to 2022. Sample sizes ranged from 10 to 15,602 across studies. The factors affecting older PLWH's experience of and issues with medicines were co-morbidities, health-related quality of life, polypharmacy, drug interactions, adverse drug reactions, adherence, medicine burden, treatment burden, stigma, social support, and patient-healthcare provider relationships. Nine interventions were identified to target older persons, five aimed at improving medication adherence, two to reduce drug interactions, and two for medicine self-management initiatives.

CONCLUSION

Further in-depth research is needed to understand older PLWH's experiences of medicines and their priority issues. Adherence-focused interventions are predominant, but there is a scarcity of interventions aimed at improving medicine experiences for this population. Multi-faceted interventions are needed to achieve medicine optimisation outcomes for PLWH.

TRIAL REGISTRATION

This study is registered with PROSPERO registration number: CRD42020188448.