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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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Sterman FL, Lalezari JP, Kowalczyk UM, Main DW, Grant EM, Caro L, Manning CM, Burke RL. Bictegravir/emtricitabine/tenofovir alafenamide plus doravirine in highly treatment-experienced men with multidrug-resistant HIV. AIDS 2023; 37:1057-1064. [PMID: 36927740 DOI: 10.1097/qad.0000000000003513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of switching highly treatment-experienced people with HIV (HTE PWH) from rilpivirine/emtricitabine/tenofovir alafenamide (RPV/FTC/TAF) plus dolutegravir (DTG) to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) plus doravirine (DOR). A pharmacokinetic (PK) analysis was conducted to assess the potential interaction between BIC and DOR. DESIGN AND METHODS This open-label switch trial enrolled HTE PWH from a primary care private practice in the United States. Eligible participants were male, aged ≥45 years, with documented viral resistance to protease inhibitors, nucleoside reverse transcriptase inhibitors, and/or nonnucleoside reverse transcriptase inhibitors but no resistance to RPV or DOR, and no K65R or T69 insertion mutations. Virologic suppression (≤50 copies/ml) while on RPV/FTC/TAF plus DTG for ≥6 months was required prior to enrollment. The primary endpoint of the study was virologic suppression (<50 and <200 copies/ml) at 48 weeks. Secondary endpoints included safety, tolerability, changes in body mass index (BMI), and identification of PK parameters of BIC and DOR. RESULTS Twenty males [median age: 65 years (range, 46-74), median time since HIV diagnosis: 37 years (range, 12-42)] completed the study. BIC/FTC/TAF plus DOR was well tolerated with no serious or treatment-related adverse events reported and no appreciable changes in BMI from baseline to Week 48. At Week 48, 100% of participants had <50 viral copies/ml. PK parameters for BIC and DOR ( n = 10) were consistent with published data. CONCLUSIONS Switching from RPV/FTC/TAF plus DTG to BIC/FTC/TAF plus DOR was well tolerated and efficacious in HTE men aged ≥45 years with HIV.
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Affiliation(s)
- Felicia L Sterman
- Gilead Sciences, Inc, Foster City
- Quest Clinical Research, San Francisco, California
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Camps-Vilaró A, Pérez-Fernández S, Subirana I, Teira R, Estrada V, Domingo P, Dégano IR, Marrugat J. Standardized Comparison of Cardiovascular Risk Factors Prevalence in Spanish Women and Men Living with HIV and in the General Population. J Pers Med 2021; 11:jpm11111085. [PMID: 34834438 PMCID: PMC8621654 DOI: 10.3390/jpm11111085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
People living with HIV (PLWH) have an increased risk of cardiovascular (CV) disease, likely due to a higher prevalence of CV risk factors. We compared the age-standardized prevalence and management of CV risk factors in PLWH to that of the general population in Spain. Blood pressure, lipid, glucose, and anthropometric profiles were cross-sectionally compared along with the treatment of hypertension, dyslipidemia, and diabetes in a general population cohort and a PLWH cohort. Prevalence rates were standardized by the direct method by 10-year age groups in European standard populations and stratified by gender. We included 47,593 individuals aged 35 to 74 years, 28,360 from the general population cohort and 19,233 from the PLWH cohort. Compared to the general population, PLWH had a higher concentration of triglycerides (>35 mg/dL in women and >26 mg/dL in men) and a higher prevalence of smoking (>23% and >17%) and diabetes (>9.9% and >8.5%). The prevalence of treated diabetes, hypertension, and dyslipidemia were up to three-fold lower in both women and men living with HIV. There was a significant difference in PLWH compared to the general population in the lipid, glucose, and anthropometric profile. In addition, PLWH were less often treated for diagnosed diabetes, hypertension, and dyslipidemia.
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Affiliation(s)
- Anna Camps-Vilaró
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Silvia Pérez-Fernández
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - Isaac Subirana
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Ramon Teira
- Infectious Diseases Unit, Hospital Sierrallana, 39300 Torrelavega, Spain;
| | - Vicente Estrada
- Infectious Diseases Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Pere Domingo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Irene R. Dégano
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
- Correspondence: (I.R.D.); (J.M.); Tel.: +34-9-3316-0714 (I.R.D.); +34-9-3316-0733 (J.M.); Fax: +34-9-3316-0796 (I.R.D. & J.M.)
| | - Jaume Marrugat
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: (I.R.D.); (J.M.); Tel.: +34-9-3316-0714 (I.R.D.); +34-9-3316-0733 (J.M.); Fax: +34-9-3316-0796 (I.R.D. & J.M.)
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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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Baker V, Nkhoma K, Trevelion R, Roach A, Winston A, Sabin C, Bristowe K, Harding R. “I have failed to separate my HIV from this pain”: the challenge of managing chronic pain among people with HIV. AIDS Care 2021:1-9. [PMID: 33443450 DOI: 10.1080/09540121.2020.1869148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pain is a highly prevalent and burdensome symptom among people with HIV (PWH). This study aims to identify how the experience of living with HIV and chronic pain influences pain beliefs, health-seeking and pain management. Thirty-nine purposively sampled PWH with chronic pain (sample characteristics = 61% women, 79% Black, Asian and minority ethnic groups, 18% men who have sex with men, 45-54 median age category) participated in focus groups in London. Focus groups were co-facilitated with community members. Transcripts wereanalysed using a thematic approach. Findings revealed that HIV stigma, fractured care pathways, and general practitioners' lack of HIV training are barriers to supported pain management. Unaddressed pain results in poorer mental health and reduced quality of life, which has important clinical implications for HIV treatment adherence. Creating HIV-specific pain resources, activating social networks, and pain self-management techniques are potential solutions. Person-centred assessment and HIV training is needed to help clinicians identify PWH with chronic pain. Clear guidelines need to be developed to identify which health service providers are responsible for chronic pain management in PWH. This study generated a refined version of the Fear Avoidance Model that introduces a dimension of HIV-specific behaviours that impact PWHs seeking chronic pain management.
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Affiliation(s)
- V. Baker
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - K. Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | | | - A. Roach
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - A. Winston
- Faculty of Medicine, Department of Infectious Disease, Imperial College London, London, England
| | - C. Sabin
- Faculty of Population Health Sciences, Department of Infection & Population Health, University College London, London, England
| | - K. Bristowe
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - R. Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
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Cianelli R, Villegas N, Lewis-Pierre L, Valdes B, Iriarte E. Predictors of End of Life Discussions Among Minority Older Women Living With HIV Infection. Am J Hosp Palliat Care 2020; 38:583-589. [PMID: 33213192 DOI: 10.1177/1049909120971826] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Among the 39,782 newly HIV diagnosed individuals in the U.S., 17% were aged 50+. Although premature aging, morbidity, and mortality are issues for older people living with HIV that threaten their quality of life, less attention has been focused on end of life (EOL) discussions. OBJECTIVES To examine predictors of EOL discussions with significant others, family members, and friends. METHODS Cross-sectional design was used for this study guided by the The Socio Ecological Model (SEM). Sample: 119 Black and 19 Hispanic women aged 50+ living with HIV. RESULTS Predictors of EOL discussions were education, living with a partner, religiosity, and pain, which were at the individual-intrapersonal level of the SEM. DISCUSSION Findings from this study have important implications for health policy makers and clinicians because they cast a bright light on the substantial continued effort that is needed to improve EOL discussions. .
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Affiliation(s)
- Rosina Cianelli
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.,Pontificia Universidad Catolica de Chile Escuela de Enfermeria, Santiago, Chile
| | - Natalia Villegas
- 16134University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - LaToya Lewis-Pierre
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Beatriz Valdes
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Evelyn Iriarte
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.,Pontificia Universidad Catolica de Chile Escuela de Enfermeria, Santiago, Chile
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Vega LE, Espinoza LR. Human immunodeficiency virus infection (HIV)-associated rheumatic manifestations in thepre- and post-HAART eras. Clin Rheumatol 2020; 39:2515-2522. [PMID: 32297034 PMCID: PMC7159285 DOI: 10.1007/s10067-020-05082-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022]
Abstract
Rheumatic manifestations remain an important clinical manifestation associated to HIV. To date after 4 decades of the onset of the HIV/AIDS pandemic, almost 37 million individuals are living with the infection, including close to 2 million of newly infected individuals. The status, however, of a considerable proportion of HIV/AIDS patients has changed from a near fatal disorder secondary to opportunistic infections to a chronic disease in which renal cardiovascular, diabetes, malignancy, and autoimmune co-morbid disorders have become prevalent and relevant. In addition, the spectrum of rheumatic disorders also has changed since the introduction of HAART and its diagnosis and treatment represents a challenge. The purpose of this review is to define and discuss the HIV-related rheumatic manifestations in the pre- and post-HAART eras.
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Affiliation(s)
- Luis E Vega
- Section of Rheumatology, Air Force Hospital, Aramburú Ave 2nd block, Lima, Peru.
| | - Luis R Espinoza
- Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA, 70112, USA
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Back D, Marzolini C. The challenge of HIV treatment in an era of polypharmacy. J Int AIDS Soc 2020; 23:e25449. [PMID: 32011104 PMCID: PMC6996317 DOI: 10.1002/jia2.25449] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/26/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The availability of potent antiretroviral therapy has transformed HIV infection into a chronic disease such that people living with HIV (PLWH) have a near normal life expectancy. However, there are continuing challenges in managing HIV infection, particularly in older patients, who often experience age-related comorbidities resulting in complex polypharmacy and an increased risk for drug-drug interactions. Furthermore, age-related physiological changes may affect the pharmacokinetics and pharmacodynamics of both antiretrovirals and comedications thereby predisposing elderly to adverse drug reactions. This review provides an overview of the therapeutic challenges when treating elderly PLWH (i.e. >65 years). Particular emphasis is placed on drug-drug interactions and other common prescribing issues (i.e. inappropriate drug use, prescribing cascade, drug-disease interaction) encountered in elderly PLWH. DISCUSSION Prescribing issues are common in elderly PLWH due to the presence of age-related comorbidities, organ dysfunction and physiological changes leading to a higher risk for drug-drug interactions, drugs dosage errors and inappropriate drug use. CONCLUSIONS The high prevalence of prescribing issues in elderly PLWH highlights the need for ongoing education on prescribing principles and the optimal management of individual patients. The knowledge of adverse health outcomes associated with polypharmacy and inappropriate prescribing should ensure that there are interventions to prevent harm including medication reconciliation, medication review and medication prioritization according to the risks/benefits for each patient.
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Affiliation(s)
- David Back
- Department of Molecular and Clinical PharmacologyUniversity of LiverpoolLiverpoolUnited Kingdom
| | - Catia Marzolini
- Department of Molecular and Clinical PharmacologyUniversity of LiverpoolLiverpoolUnited Kingdom
- Division of Infectious Diseases and Hospital EpidemiologyDepartments of Medicine and Clinical ResearchUniversity Hospital of Basel and University of BaselBaselSwitzerland
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Pharmacokinetic profiles of boosted darunavir, dolutegravir and lamivudine in aging people living with HIV. AIDS 2020; 34:103-108. [PMID: 31490233 DOI: 10.1097/qad.0000000000002372] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The pharmacokinetics of antiretroviral drugs may differ in elderly people living with HIV (PLWH) because of age-related physiological changes. We aimed to assess the pharmacokinetics of several antiretroviral drugs in aging PLWH enrolled in the Swiss HIV Cohort (SHCS). DESIGN Full pharmacokinetic profiling nested in a multicenter, observational, prospective cohort study. Additional collection of single point pharmacokinetic data during SHCS follow-up visits (unselected PLWH). METHODS PLWH were eligible for the full pharmacokinetics investigation if they were over the age of 55 years, on a stable boosted darunavir-containing or dolutegravir-containing regimen. Single point measurements were prospectively collected during SHCS follow-up visits to compare antiretroviral drug exposure in aging (≥65 years) and younger (<65 years) PLWH. RESULTS Nineteen PLWH with a median age of 64 years participated in the full pharmacokinetic investigations. Single point pharmacokinetic data were collected for 804 PLWH with a median age of 52 years. Boosted darunavir clearance was 40% lower in aging (≥65 years) compared with younger (<65 years) PLWH, consistent with other drugs predominantly metabolized by CYP3A. Dolutegravir exposure was similar between age groups whereas lamivudine exposure increased by 11% in aging PLWH. Median boosted darunavir, dolutegravir and lamivudine t1/2 were 148%, 45% and 32% higher in aging compared with younger PLWH. CONCLUSION Advanced age did not affect boosted darunavir exposure to a clinically significant extent despite the observed high variability in exposure. Age minimally affected dolutegravir and lamivudine exposure. Thus, dose adjustment based on age is a priori not warranted.
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Abstract
Introduction: Combined antiretroviral therapy has transformed HIV infection into a chronic disease thus people living with HIV (PLWH) live longer. As a result, the management of HIV infection is becoming more challenging as elderly experience age-related comorbidities leading to complex polypharmacy and a higher risk for drug-drug or drug-disease interactions. Furthermore, age-related physiological changes affect pharmacokinetics and pharmacodynamics thereby predisposing elderly PLWH to incorrect dosing or inappropriate prescribing and consequently to adverse drug reactions and the subsequent risk of starting a prescribing cascade. Areas covered: This review discusses the demographics of the aging HIV population, physiological changes and their impact on drug response as well as comorbidities. Particular emphasis is placed on common prescribing issues in elderly PLWH including drug-drug interactions with antiretroviral drugs. A PubMed search was used to compile relevant publications until February 2019. Expert opinion: Prescribing issues are highly prevalent in elderly PLWH thus highlighting the need for education on geriatric prescribing principles. Adverse health outcomes potentially associated with polypharmacy and inappropriate prescribing should promote interventions to prevent harm including medication reconciliation, medication review, and medication prioritization according to the risks/benefits for a given patient. A multidisciplinary team approach is recommended for the care of elderly PLWH.
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Affiliation(s)
- Catia Marzolini
- a Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital of Basel and University of Basel , Basel , Switzerland.,b Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool , UK
| | - Françoise Livio
- c Service of Clinical Pharmacology, Department of Laboratories , University Hospital of Lausanne , Lausanne , Switzerland
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Burden of Exposure to Potential Interactions Between Antiretroviral and Non-Antiretroviral Medications in a Population of HIV-Positive Patients Aged 50 Years or Older. J Acquir Immune Defic Syndr 2019; 78:193-201. [PMID: 29767640 DOI: 10.1097/qai.0000000000001653] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND As HIV-infected patients aged 50 years or older are at increased risk of comorbidities and multidrug treatments, we examined their exposure to the potential drug-drug interactions (PDDIs) of antiretroviral (ARV) and other medications. METHODS This cross-sectional study involved the patients aged 50 years or older receiving ARV and non-ARV medications at our clinic. PDDIs were identified using the University of Liverpool HIV Drug Interaction Checker. Logistic regression models were used to assess risk factors for PDDIs. The American Geriatrics Society Beers Criteria were used to identify potentially inappropriate medications (PIMs). RESULTS A total of 395 (53.9%) of 744 patients showed ≥1 PDDI: 47.4% ≥ 1 amber-PDDI (comedications requiring appropriate management) and 5.6% ≥ 1 red-PDDI (contraindicated comedications). A higher risk of PDDIs was associated with the use of ≥5 medications (P < 0.001), of antiosteoporotics (P < 0.001), calcium channel blockers (P < 0.001), anti-benign prostatic hypertrophy agents (P < 0.001), hypnotics/sedatives (P = 0.022), and anticoagulants (P = 0.006). A higher risk of red-PDDIs was associated with the use of antacids (P < 0.001), anti-benign prostatic hypertrophy agents (P < 0.001) and antipsychotics (P = 0.023). The use of nucleoside reverse transcriptase inhibitor + nonnucleoside reverse transcriptase inhibitor and nucleoside reverse transcriptase inhibitor + integrase strand transfer inhibitor rather than protease inhibitor-based regimens was associated with a reduced risk of PDDIs (P < 0.001). Overall, 119 (16.0%) patients were receiving PIMs (mainly hypnotics/sedatives) and 49 (41.2%) of them had PDDIs able to increase the blood levels of these medications. CONCLUSIONS Older patients with HIV are highly exposed to PDDIs between ARVs and comedications. The knowledge of their complete medication regimens and the screening for PDDIs and PIMs is therefore crucial to prevent drug-related adverse outcomes in this population.
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Human Immunodeficiency Virus Infection: Spectrum of Rheumatic Manifestations. INFECTIONS AND THE RHEUMATIC DISEASES 2019. [PMCID: PMC7120519 DOI: 10.1007/978-3-030-23311-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emerging and reemerging viral infections have been a characteristic feature of the past several decades, with HIV infection being the most important example of an emergent viral infection. To date, the status of a considerable proportion of HIV/AIDS patients has changed from a near-fatal disorder secondary to opportunistic infections to a chronic disease in which a variety of co-morbid conditions have become prevalent and relevant. Arthralgia and myalgias are the most common symptoms. The rate of spondyloarthritis varies according to the geographic area, genetic and mode of transmission. Most RA and SLE patients might go into remission after the development of AIDS, but also there are patients that continue with active disease. Prevalence of DILS is highest among African Americans in less advanced stages. PAN is clinically less aggressive and peripheral neuropathy is the most common clinical manifestation. Anti-phospholipid syndrome (APS), systemic sclerosis and poly-dermatomyositis are uncommon. After the introduction of combination antiretroviral therapy (cART), a decline of spondyloarthritis disorders and of DILS and development of new syndromes such as IRIS, osteoporosis and avascular bone necrosis have occurred. The treatment of patients with rheumatic diseases and HIV infection remains a challenge.
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Freedman SF, Johnston C, Faragon JJ, Siegler EL, Del Carmen T. Older HIV-infected adults. Complex patients (III): Polypharmacy. Eur Geriatr Med 2018; 10:199-211. [PMID: 31983932 DOI: 10.1007/s41999-018-0139-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Polypharmacy is a well-described problem in the geriatric population. It is a relatively new problem for people living with HIV (PLWH), as this group now has a life expectancy approaching that of the general population. Defining polypharmacy for PLWH is difficult, since the most common traditional definition of at least five medications would encompass a large percentage of PLWH who are on antiretrovirals (ARVs) and medications for other medical comorbidities. Even when excluding ARVs, the prevalence of polypharmacy in PLWH is higher than the general population, and not just in resource-rich countries. Using a more nuanced approach with "appropriate" or "safer" polypharmacy allows for a better framework for discussing how to mitigate the associated risks. Some of the consequences of polypharmacy include adverse effects of medications including the risk of geriatric syndromes, drug-drug interactions, decreased adherence, and over- and undertreatment of medical comorbidities. Interventions to combat polypharmacy include decreasing pill burden-specifically with fixed-dose combination (FDC) tablets- and medication reconciliation/deprescription using established criteria. The goal of these interventions is to decrease drug interactions and improve quality of life and outcomes. Some special populations of interest within the community of PLWH include those with chronic pain, substance abuse, or requiring end of life care. A final look into the future of antiretroviral therapy (ART) shows the promise of possible two-drug regimens, which can help reduce the above risks of polypharmacy.
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Affiliation(s)
- Samuel F Freedman
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Carrie Johnston
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | | | - Eugenia L Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Tessa Del Carmen
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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Guaraldi G, Pintassilgo I, Milic J, Mussini C. Managing antiretroviral therapy in the elderly HIV patient. Expert Rev Clin Pharmacol 2018; 11:1171-1181. [PMID: 30444968 DOI: 10.1080/17512433.2018.1549484] [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] [Indexed: 12/12/2022]
Abstract
Introduction: Owing to more effective and less toxic antiretroviral therapy (ART), people living with HIV (PLWH) live longer, a phenomenon expected to grow in the next decades. With advancing age, effectively treated PLWH experience not only a heightened risk for non-infective comorbidities and multimorbidity, but also for geriatric syndromes and frailty. In addition, older adults living with HIV (OALWH) have a higher prevalence of so-called iatrogenic triad described as polypharmacy (PP), potentially inappropriate medication use, and drug-drug interactions. Areas covered: This review will focus the management of ART in OALWH. We will discuss iatrogenic triad and best way to address PP. Special focus will be given to pharmacokinetic and pharmacodynamic aspects of ART in the elderly, evaluation of ART toxicities, and specific ART strategies commonly used in this population. Expert commentary: Research should be focused on recruiting more OALWH, frail individuals in particular, into the clinical trials and specific geriatric outcome need to be considered together with traditional viroimmunological outcomes.
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Affiliation(s)
- Giovanni Guaraldi
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Ines Pintassilgo
- c Internal Medicine Department , Hospital Garcia de Orta , Almada , Portugal
| | - Jovana Milic
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy.,d Clinical and Experimental Medicine PhD Program , University of Modena and Reggio Emilia , Modena , Italy
| | - Cristina Mussini
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy
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Derivation and internal validation of a mortality risk index for aged people living with HIV: The Dat'AIDS score. PLoS One 2018; 13:e0195725. [PMID: 29672628 PMCID: PMC5908189 DOI: 10.1371/journal.pone.0195725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/28/2018] [Indexed: 12/30/2022] Open
Abstract
Objective The objective was to develop a multivariable prognostic index for overall mortality over a five-year span integrating classical HIV biomarkers and comorbidities in people living with HIV (PLHIV) aged 60 or older. Design Prospective multicenter cohort study from the French Dat’AIDS cohort. Methods All HIV-1 infected patients aged 60 years or older on 1st January 2008 were included. Sociodemographic data, CD4 cell count, CD4 nadir, HIV viral load, history of comorbidities, hepatitis co-infections and laboratory parameters at baseline were considered as potential prognostic variables. Primary outcome was all-cause mortality. Results Among 1415 patients included, we derived a score comprising the following predictors: Age (65–74: 1 point; ≥75: 8 points), CD4 cell count (200–349: 3 points; <200: 6 points), non-HIV related cancer (6 points), cardiovascular disease (8 points), estimated glomerular filtration rate (30–59 mL/min/1.73m2: 5 points; <30mL/min/1.73m2: 16 points), cirrhosis (13 points), low body mass index (<18.5 kg/m2, 10 points), anemia (6 points). Mean observed score was 7.0 ± 8.0 and ranged from 0 to 45. Score categories defined 4 risk groups for mortality: low, moderate, high and very high risk (5-year survival probability 0.95 (95%CI[0.93–0.97]), 0.90 (95%CI[0.87–0.92]), 0.77 (95%CI[0.68–0.84]) and 0.54 (95%CI[0.43–0.63]) respectively). The score showed good discrimination (C-statistic = 0.76) and calibration. Conclusions We propose a multivariable prognostic score for mortality among PLHIV aged 60 or over, who will become the predominant population in future years in western populations. It could be a useful tool for research, for developing preventive and treatment strategies according to risk group, and for risk assessment by clinicians.
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Abstract
BACKGROUND HIV infection and inflammatory and autoimmune diseases (IADs) are both related to immune dysfunction. Epidemiological data on IAD in patients living with HIV (PLHIV) are scarce. The aim of this study was thus to estimate the prevalence of 26 IAD among PLHIV followed in a large French multicenter cohort in the combination antiretroviral therapy (cART) era (from January 2000 to July 2013), and to describe their occurrence according to cART onset, the immuno-virological status of patients and hepatitis C virus (HCV) and/or hepatitis B virus coinfection. METHOD AND RESULTS During the study period, 33 403 PLHIV were included in the Dat'AIDS cohort; 1381 patients with an IAD were identified. The most prevalent IADs were psoriasis, sarcoidosis, rheumatoid arthritis, ankylosing spondyloarthritis, Grave's disease, autoimmune hemolytic anemia, immune thrombocytopenia and chronic inflammatory bowel disease. In contrast, the prevalence of systemic lupus erythematosus and multiple sclerosis were low. Most patients (59%) developed IAD after HIV infection with a mean delay of 10.6 ± 6.4 years. Compared with the entire cohort, HCV coinfection was significantly more frequent in patients with psoriasis, Grave's disease and immune thrombocytopenia, and chronic hepatitis B in patients was more frequent in those with immune thrombocytopenia and autoimmune hemolytic anemia. Among patients developing IAD after the diagnosis of HIV infection, 572 (70%) were on antiretroviral therapy and 419 of them (73%) had undetectable HIV viral load. CONCLUSION Our study showed that some IAD are not rare among PLHIV and occur mostly in patients with immuno-virological control under cART. The higher frequency of HCV or hepatitis B virus coinfection for some IAD is also confirmed.
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