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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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Zino L, Wit F, Rokx C, den Hollander JG, van der Valk M, Richel O, Burger DM, Colbers A. Outcomes of Bariatric Surgery in People With Human Immunodeficiency Virus: A Retrospective Analysis From the ATHENA Cohort. Clin Infect Dis 2023; 77:1561-1568. [PMID: 37392435 PMCID: PMC10686945 DOI: 10.1093/cid/ciad404] [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: 03/06/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND The implications of bariatric surgery (BS) on virologic and metabolic outcomes in people with human immunodeficiency virus (HIV; PWH) on antiretroviral therapy (ART) are unknown. METHODS Here, we report a retrospective analysis up to 18 months post-BS in PWH from the AIDS Therapy evaluation in The Netherlands (ATHENA) cohort with data from all dutch HIV treating Centers. Primary end points were a confirmed virologic failure (2 consecutive HIV-RNA measurements >200 copies/mL) and the percentage of patients who achieved >20% total body weight loss up to 18 months post-BS. Switches from baseline ART and trough plasma concentrations of antiretrovirals were also reported post-BS. Metabolic parameters and medication usage were compared pre- and post-BS. RESULTS Fifty-one patients were included. One case of confirmed virologic failure and 3 cases with viral blips were detected in this cohort up to 18 months post-BS. Eighty-five percent of patients achieved >20% total body weight loss at 18 months post-BS, with a mean difference from baseline (95% confidence interval) of -33.5% (-37.7% to -29.3%). Trough plasma concentrations of measured antiretroviral agents were all above minimum effective concentrations, except for 1 sample of darunavir. Lipid profiles, but not serum creatinine and blood pressure, improved significantly (P < .01) post-BS. Total medications and obesity-related comedications declined from 203 to 103 and from 62 to 25, respectively, at 18 months post-BS. CONCLUSIONS BS was an effective intervention for weight loss and lipid control in PWH using ART in this cohort with no clear link to poor virologic outcomes.
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Affiliation(s)
- Leena Zino
- Department of Pharmacy and Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ferdinand Wit
- Data Analysis, Reporting & Research Unit, Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Casper Rokx
- Department of Medical Microbiology and Infectious Diseases and Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan G den Hollander
- Department of Internal Medicine and Infectious Diseases, Maasstad ziekenhuis, Rotterdam, The Netherlands
| | - Mark van der Valk
- Data Analysis, Reporting & Research Unit, Stichting HIV Monitoring, Amsterdam, The Netherlands
- Department of Infectious Diseases, Amsterdam Institute for Infectious Diseases, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Olivier Richel
- Department of Infectious Disease and Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy and Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela Colbers
- Department of Pharmacy and Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
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Alnaim AA, Almuhanna SM, AlHussain AK, Alkhteeb NA, Alabdullah ZA. Prevalence of polypharmacy and medication-related quality of life among adult patients in Al-Ahsa, Saudi Arabia. J Med Life 2023; 16:1415-1420. [PMID: 38107723 PMCID: PMC10719800 DOI: 10.25122/jml-2023-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/15/2023] [Indexed: 12/19/2023] Open
Abstract
Polypharmacy, often defined as the concurrent use of five or more medications, has become increasingly common due to various factors, including shifts in lifestyle and a rise in health-related issues among individuals. However, using multiple medications could bring more issues to the patient, as it is linked to poor health outcomes, including medication nonadherence, adverse pharmacological effects, and decreased quality of life (QoL). This study aimed to determine the prevalence of polypharmacy and identify drug-related problems among adult patients in Al-Ahsa. A cross-sectional study was conducted among adult patients living in Al-Ahsa, Saudi Arabia, taking five or more medications. A self-administered questionnaire was distributed among the target population using an online survey. The questionnaire included sociodemographic data (i.e., age, sex, education, etc.), a questionnaire to assess behaviors regarding the use of polypharmacy, and a 10-item questionnaire to measure medication-related quality of life (MRQoL). In total, 196 of the 1,088 patients surveyed took five or more medications, indicating an 18% prevalence of polypharmacy. Among the 196 patients, 26.5% reported poor medication-related QoL. In univariate analysis, sex, occupational status, average monthly income, hypertension, asthma, difficulty managing medications, and side effects experienced were significantly associated with MRQoL. Independent significant predictors of poor MRQoL were having asthma and difficulty managing medications. The prevalence of poor medication-related quality of life among adult patients in our region was 26.5%, lower than that in previous studies. Poor MRQoL was associated with lower monthly income, hypertension, asthma, side effects, and difficulty managing medications.
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Affiliation(s)
- Abdullah Abdulaziz Alnaim
- Department of Family and Community Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
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da Silva RPN, Marins LMS, Guaraldo L, Luz PM, Cardoso SW, Moreira RI, Oliveira VDG, Veloso VG, Grinsztejn B, Estrela R, Torres TS. Pharmacotherapeutic profile, polypharmacy and its associated factors in a cohort of people living with HIV in Brazil. AIDS Res Ther 2023; 20:57. [PMID: 37605195 PMCID: PMC10440883 DOI: 10.1186/s12981-023-00548-6] [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: 08/19/2022] [Accepted: 07/18/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The increased survival provided by the access, development, and evolution of antiretroviral drugs (ARV) greatly increased the life expectancy of people living with HIV (PWH). This has also led to an increased occurrence of diseases or morbidities related to aging. In individuals with multiple comorbidities, the simultaneous use of multiple medications, also known as polypharmacy, is common, and rational use of medications is essential. This study aims to describe the pharmacotherapeutic profile, estimate the prevalence of polypharmacy and identify factors associated with polypharmacy in a cohort of adult PWH from a referral unit in Rio de Janeiro, Brazil. METHODS Cross-sectional study including PWH on ARV who received at least one medical prescription (outpatient/hospitalized) in 2019. We described the proportion of prescribed medications according to ARV and Anatomical Therapeutic Chemical (ATC) classes stratified by age (< 50 vs. ≥50 years). Polypharmacy was defined as ≥ 5 medications prescribed beyond ARV. Logistic regression models assessed demographic and clinical factors associated with polypharmacy. RESULTS A total of 143,306 prescriptions of 4547 PWH were analyzed. Median age was 44.4 years (IQR:35.4-54.1) and 1615 (35.6%) were ≥ 50 years. A total of 2958 (65.1%) participants self-identified as cisgender man, 1365 (30.0%) as cisgender woman, and 224 (4.9%) as transgender women. Most self-declared Black/Pardo (2582; 65.1%) and 1984 (44.0%) completed elementary education or less. Median time since HIV diagnosis was 10.9 years (IQR:6.2-17.7). Most frequently prescribed concomitant medications were nervous system (64.8%), antiinfectives for systemic use (60.0%), alimentary tract and metabolism (45.9%), cardiovascular system (40.0%) and respiratory system (37.1%). Prevalence of polypharmacy was 50.6% (95%CI: 49.2-52.1). Model results indicated that being older, self-identify as cisgender woman, having less education and longer time since HIV diagnosis increased the odds of polypharmacy. CONCLUSIONS We found high rates of polypharmacy and concomitant medication use in a cohort of PWH in Brazil. Targeted interventions should be prioritized to prevent interactions and improve treatment, especially among individuals using central nervous system and cardiovascular medications, as well as certain groups such as cisgender women, older individuals and those with lower education. Standardized protocols for continuous review of patients' therapeutic regimens should be implemented.
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Affiliation(s)
- Robson Pierre Nascimento da Silva
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Luana M S Marins
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Lusiele Guaraldo
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Sandra W Cardoso
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Vanessa da Gama Oliveira
- Serviço de Farmácia (Sefarm), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Rita Estrela
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
- Laboratório de Farmacometria, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Thiago S Torres
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil.
- , Av Brasil 4365 Manguinhos, 21045-360, Rio de Janeiro, Brazil.
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Elbur AI, Ghebremichael M, Konkle-Parker D, Jones DL, Collins S, Adimora AA, Schneider MF, Cohen MH, Tamraz B, Plankey M, Wilson T, Adedimeji A, Haberer JE, Jacobson DL. Dual trajectories of antiretroviral therapy adherence and polypharmacy in women with HIV in the United States. AIDS Res Ther 2023; 20:29. [PMID: 37179294 PMCID: PMC10182649 DOI: 10.1186/s12981-023-00520-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Polypharmacy, using five or more medications, may increase the risk of nonadherence to prescribed treatment. We aimed to identify the interrelationship between trajectories of adherence to antiretroviral therapy (ART) and polypharmacy. METHODS We included women with HIV (aged ≥ 18) enrolled in the Women's Interagency HIV Study in the United States from 2014 to 2019. We used group-based trajectory modeling (GBTM) to identify trajectories of adherence to ART and polypharmacy and the dual GBTM to identify the interrelationship between adherence and polypharmacy. RESULTS Overall, 1,538 were eligible (median age of 49 years). GBTM analysis revealed five latent trajectories of adherence with 42% of women grouped in the consistently moderate trajectory. GBTM identified four polypharmacy trajectories with 45% categorized in the consistently low group. CONCLUSIONS The joint model did not reveal any interrelationship between ART adherence and polypharmacy trajectories. Future research should consider examining the interrelationship between both variables using objective measures of adherence.
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Affiliation(s)
| | | | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, MS USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Shelby Collins
- Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA USA
| | - Adaora A. Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Michael F. Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL USA
| | - Bani Tamraz
- School of Pharmacy, University of California, San Francisco, San Francisco, CA USA
| | - Michael Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC USA
| | - Tracey Wilson
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY USA
| | - Adebola Adedimeji
- Dept of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Denise L. Jacobson
- Center for Biostatistics in AIDS Research, Department of Biostatistics , Harvard T. H. Chan School of Public Health, Boston, MA USA
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Yu F, Hsiao YH, Park S, Kambara K, Allan B, Brough G, Hwang TF, Dang N, Young B, Patel R, Maldonado A, Okoli C. The Influence of Anticipated HIV Stigma on Health-related Behaviors, Self-rated Health, and Treatment Preferences Among People Living with HIV in East Asia. AIDS Behav 2023; 27:1287-1303. [PMID: 36348191 PMCID: PMC10036452 DOI: 10.1007/s10461-022-03865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
Abstract
Long-acting injectable regimens for HIV treatment have been developed which are less frequent, more discreet, and more desirable for some people living with HIV (PLHIV) and may help reduce stigma-related barriers to HIV treatment. However, there is little information on the relationship between reported stigma and preference for these newer treatments. We characterized anticipated, experienced, and internalized HIV stigma and examined the associations with treatment preferences among an international sample of PLHIV. Data came from the international, web-based, cross-sectional study called "Positive Perspectives" conducted among PLHIV aged ≥ 18 years in 25 geographic locations during 2019 (n = 2389). Descriptive analyses were stratified among East Asian (n = 230) vs. non-Asian (n = 2159) participants. Results showed that prevalence of anticipated stigma was significantly higher among East Asian than non-Asian participants (72.2%[166/230] vs. 63.8%[1377/2159], p = 0.011). A significantly higher percentage of East Asian (68.7%[158/230]) than non-Asian participants (43.3%[935/2159] indicated that someone finding their HIV pills would cause them much "stress or anxiety" (p < 0.001). Actions taken by some PLHIV to prevent unwanted disclosure included restricting who they shared their HIV status with, hiding their HIV pills, or even skipping a dose altogether because of privacy concerns. Overall, 50.0%[115/230] East Asian participants believed HIV would reduce their lifespan and 43.0%[99/230] no longer planned for their old age because of HIV. Anticipated stigma was strongly associated with receptivity to non-daily regimens. Concerted efforts to reduce stigma and deliver flexible treatment options that address the unmet treatment needs of PLHIV, including confidentiality concerns, may improve their health-related quality of life.
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Affiliation(s)
- Fei Yu
- Danlan Beijing Media Limited, Beijing, China
| | | | | | - Keita Kambara
- Japanese Network of People living with HIV/AIDS, Tokyo, Japan
| | - Brent Allan
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia
- International Council of AIDS Service Organizations (ICASO), Toronto, Canada
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Massawe AT, Shayo GA, Mugusi SF. Polypharmacy and health related quality of life among older adults on antiretroviral therapy in a tertiary hospital in Tanzania: a hospital-based cross-sectional study. BMC Infect Dis 2023; 23:179. [PMID: 36973690 PMCID: PMC10041806 DOI: 10.1186/s12879-023-08150-x] [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: 12/17/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) chronicity in the midst of old age multiplies the risk for chronic non communicable diseases. The old are predisposed to drug-drug interactions, overlapping toxicities and impairment of the quality of life (QoL) due to age-related physiological changes. We investigated polypharmacy, QoL and associated factors among older HIV-infected adults at Muhimbili National hospitals in Dar es Salaam Tanzania. METHODS A hospital-based cross sectional study enrolled adults aged 50 years or older who were on antiretroviral therapy (ART) for ≥ 6 months. Participants' Information including the number and type of medications used in the previous one week were recorded. Polypharmacy was defined as concurrent use of five or more non-HIV medications. A World Health Organization QoL questionnaire for people living with HIV on ART (WHOQoL HIV BREF) was used to assess QoL. A score of ≤ 50 meant poor QoLwhile > 50 meant good QoL. Polypharmacy and QoL are presented as proportions and compared using Chi-square test. Association between various factors and polypharmacy or QoL was assessed using modified Poisson regression. A p-value of < 0.05 was considered significant. RESULTS A total of 285 patients were enrolled. The mean (SD) age was 57(± 6.88) years. Females were the majority (62.5%), and 42.5% were married. Polypharmacy was seen in 52 (18.2%) of participants. Presence of co-morbidities was independently associated with polypharmacy (p < 0.001). The mean(SD) score QoL for the study participants was 67.37 ± 11.Poor QoL was seen in 40 (14%) participants.All domains' mean score were above 50, however social domain had a relatively lowmean scoreof 68 (± 10.10). Having no formal or primary education was independently associated with poor QoL (p = 0.021). CONCLUSION The prevalence of polypharmacy was modestly high and was linked to the presence of co-morbidities. No formal and/or primary education was associated with poor QoL, where by social domain of QoL was the most affected.
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Affiliation(s)
- Antimon Tibursi Massawe
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar Es Salaam, Tanzania.
| | - Grace Ambrose Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar Es Salaam, Tanzania
| | - Sabina Ferdinand Mugusi
- Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar Es Salaam, Tanzania
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Sarma P, Cassidy R, Corlett S, Katusiime B. Ageing with HIV: Medicine Optimisation Challenges and Support Needs for Older People Living with HIV: A Systematic Review. Drugs Aging 2023; 40:179-240. [PMID: 36670321 PMCID: PMC9857901 DOI: 10.1007/s40266-022-01003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Priya Sarma
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Kent, UK.
| | - Rebecca Cassidy
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - Sarah Corlett
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Kent, UK
| | - Barbra Katusiime
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Kent, UK
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Elbur AI, Ghebremichael M, Konkle-Parker D, Jones DL, Collins S, Adimora AA, Schneider MF, Cohen MH, Tamraz B, Plankey M, Wilson T, Adedimeji A, Haberer JE, Jacobson DL. Dual Trajectories of Antiretroviral Therapy Adherence and Polypharmacy in Women with HIV in the United States. RESEARCH SQUARE 2023:rs.3.rs-2443973. [PMID: 36747684 PMCID: PMC9901001 DOI: 10.21203/rs.3.rs-2443973/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Polypharmacy, using five or more medications, may increase the risk of nonadherence to prescribed treatment. We aimed to identify the interrelationship between trajectories of adherence to antiretroviral therapy (ART) and polypharmacy. Methods We included women with HIV (aged ≥ 18) enrolled in the Women's Interagency HIV Study in the United States from 2014 to 2019. We used group-based trajectory modeling (GBTM) to identify trajectories of adherence to ART and polypharmacy and the dual GBTM to identify the interrelationship between adherence and polypharmacy. Results Overall, 1,538 were eligible (median age of 49 years). GBTM analysis revealed five latent trajectories of adherence with 42% of women grouped in the consistently moderate trajectory. GBTM identified four polypharmacy trajectories with 45% categorized in the consistently low group. Conclusions The joint model did not reveal any interrelationship between ART adherence and polypharmacy trajectories. Future research should consider examining the interrelationship between both variables using objective measures of adherence.
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Matza LS, Howell TA, Chounta V, van de Velde N. Patient preferences and health state utilities associated with the treatment process of antiretroviral therapy for people living with HIV. Qual Life Res 2023; 32:531-541. [PMID: 36512302 PMCID: PMC9746581 DOI: 10.1007/s11136-022-03290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE People living with HIV (PLHIV) have reported challenges associated with daily oral antiretroviral therapy (ART), including missed doses, negative psychological impact, and difficulty remaining discreet while at home or traveling. Recently approved long-acting injectable (LAI) ART may help eliminate these concerns. The purpose of this study was to examine patient preferences and estimate health state utilities associated with oral and LAI treatment for ART. METHODS Four health state vignettes were developed based on published literature, clinician interviews, and a pilot study. All vignettes included the same description of HIV, but differed in treatment regimens: (A) single daily oral tablet, (B) two daily oral tablets, (C) injections once monthly, and (D) injections every two months. PLHIV in the UK reported their preferences and valued the health states in time trade-off utility interviews. RESULTS The sample included 201 PLHIV (83.1% male; mean age = 44.9y). The health states frequently selected as most preferable were D (n = 119; 59.2%) and A (n = 75; 37.3%). Utility differences among health states were relatively small, which is typical for treatment process utilities (mean utilities: A, 0.908; B, 0.905; C, 0.900; D, 0.910). Statistically significant differences in utility were found for one vs. two tablets and injections every month vs. every two months (p < 0.001). Participants' quotations highlight the wide range of reasons for treatment process preferences. CONCLUSIONS Current results indicate that many PLHIV would prefer LAI ART. The reported utilities may be useful in economic modeling comparing oral vs. LAI ART.
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Affiliation(s)
- Louis S Matza
- Patient-Centered Research, Evidera, Bethesda, MD, USA.
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11
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van Dyk R, Lammertink B, Appiah A, Plieger H, de los Rios P, Okoli C. Preference for non-daily ART is associated with perceived
extent of ART-related emotional, psychosocial, physical, and
adherence challenges among people living with HIV in the
Netherlands and other European countries. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/156768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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12
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Pacheco M, Agner JL, Myers TK, Franco J, Barile JP, Kaholokula JK, Baldwin JA. Health outcomes and healthcare utilization of Native Hawaiians and other Pacific Islanders living with HIV in Hawai'i: A mixed-methods study. ETHNICITY & HEALTH 2022; 27:1841-1858. [PMID: 34647505 PMCID: PMC9008070 DOI: 10.1080/13557858.2021.1990219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Past research shows mixed outcomes in terms of HIV-related disparities among Native Hawaiians and Pacific Islanders (NHOPI). This study investigates HIV-related disparities among NHOPI living with HIV in Hawai'i. DESIGN An explanatory sequential design was utilized. The quantitative portion analyzed survey data from a statewide Ryan White Needs Assessment (N = 398) to examine the differences in viral suppression and satisfaction with care between NHOPI and other ethnic groups. Utilizing the behavioral model for vulnerable populations (BMVP), semi-structured interviews (N = 16) were conducted next to explain what factors play a role in satisfaction with care and viral suppression when it comes to NHOPI living with HIV in Hawai'i. RESULTS Among the 398 participants 13% were NHOPI. NHOPI were more likely to have a viral load of ≥10,000 copies/mL compared to those who didn't identify as NHOPI. However, there were no significant differences for other viral load levels (20-199 or 200-9999), and only 20 participants (5.2%) had a viral load of 10,000 copies/mL or more. No significant ethnic differences were found in satisfaction with medical care. In the qualitative phase, factors from all domains of the BMVP were represented within the four themes identified: (1) Care coordination is essential- with AIDs service organizations taking the lead; (2) HIV care, as well as overall health, is defined by the effectiveness of medication; (3) Initial diagnosis is a critical moment for intervention; and (4) Aspects of culture are intangible. CONCLUSION Among NHOPI in Hawai'i who are engaged in case management, there appears to be no substantial disparities in either viral load or satisfaction with care compared to other ethnic groups. Despite this, qualitative findings provide insights on how ethnicity and culture may still be playing a role. Addressing all domains of the BMVP is crucial to addressing this.
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Affiliation(s)
- Misty Pacheco
- Department of Kinesiology and Exercise Sciences, University of Hawaii at Hilo, Hilo, HI, USA
| | - Joy Lynn Agner
- Department of Psychology, University of Hawaii at Hilo, Hilo, USA
| | - Tara K Myers
- Department of Psychology, University of Hawaii at Hilo, Hilo, USA
| | - Jeena Franco
- Department of Kinesiology and Exercise Sciences, University of Hawaii at Hilo, Hilo, HI, USA
| | - John P Barile
- Department of Psychology, University of Hawaii at Hilo, Hilo, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Julie A Baldwin
- Center for Health Equity Research and Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
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13
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Danjuma MI, Adegboye OA, Aboughalia A, Soliman N, Almishal R, Abdul H, Mohamed MFH, Elshafie MN, AlKhal A, Elzouki A, Al-Saud A, Chaponda M, Bidmos MA. Prevalence and global trends of polypharmacy among people living with HIV: a systematic review and meta-analysis. Ther Adv Drug Saf 2022; 13:20420986221080795. [PMID: 36052397 PMCID: PMC9425890 DOI: 10.1177/20420986221080795] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: There has been a rising prevalence of polypharmacy among people living with HIV (PLWH). Uncertainty however remains regarding the exact estimates of polypharmacy among these cohorts of patients. Methods: We conducted a systematic search of PubMed; EMBASE, CROI, Cochrane Database of Systematic Reviews; Science Citation Index and Database of Abstracts of Reviews of Effects for studies between 1 January 2000 and 30 June 2021 that reported on the prevalence of polypharmacy (ingestion of > 5 non-ART medications) among PLWH on antiretroviral therapy regimen (ART). Prevalence of polypharmacy among HIV-positive patients on ART with Clopper–Pearson 95% confidence intervals were presented. The heterogeneity between studies was evaluated using I2 and τ2 statistics. Results: One hundred ninety-seven studies were initially identified, 23 met the inclusion criteria enrolling 55,988 PLWH, of which 76.7% [95% confidence interval (CI): 76.4–77.1] were male. The overall pooled prevalence of polypharmacy among PLWH was 33% (95% CI: 25–42%) (I2 = 100%, τ2 = 0.9170, p < 0.0001). Prevalence of polypharmacy is higher in the Americas (44%, 95% CI: 27–63%) (I2 = 100%, τ2 = 1.0886, p < 0.01) than Europe (29%, 95% CI: 20–40%) (I2 = 100%, τ2 = 0.7944, p < 0.01). Conclusion: The pooled prevalence estimates from this synthesis established that polypharmacy is a significant and rising problem among PLWH. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies. Registration: PROSPERO: CRD42020170071 Plain Language Summary Background: In people living with HIV (PLWH), what is the prevalence of polypharmacy and is this influenced by sociodemographic factors? Methods and Results: In this systematic review and meta-analysis of 23 studies comprising 55,988 participants, we have for the first time found an estimated polypharmacy pooled prevalence of 33% among PLWH. There was a relatively higher pooled prevalence of polypharmacy among the America’s compared with European cohorts of PLWH. Conclusion: Polypharmacy among PLWH is a rising morbidity that needs urgent intervention both at policy and patient levels of care.
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Affiliation(s)
- Mohammed I Danjuma
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Oyelola A Adegboye
- Evolution Equations Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam.,Faculty of Mathematics and Statistics, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | | | - Nada Soliman
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ruba Almishal
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Haseeb Abdul
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Mohamed Nabil Elshafie
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdulatif AlKhal
- College of Medicine, QU Health, Qatar University, Doha, Qatar.,Centre for Disease Control, Hamad Medical Corporation, Doha, Qatar
| | - Abdelnaser Elzouki
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Arwa Al-Saud
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mas Chaponda
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK.,Centre for Disease Control, Hamad Medical Corporation, Doha, Qatar
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What is polypharmacy in people living with HIV/AIDS? A systematic review. AIDS Res Ther 2022; 19:37. [PMID: 35918746 PMCID: PMC9344688 DOI: 10.1186/s12981-022-00461-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/28/2022] [Indexed: 11/26/2022] Open
Abstract
Polypharmacy in people living with HIV/AIDS (PLWHA) is a rising morbidity that exacts hefty economic burden on health budgets in addition to other adverse clinical outcomes. Despite recent advances, uncertainty remains around its exact definition in PLWHA. In this systematic review and Meta-analysis, we explored relevant databases (PUBMED, EMBASE, CROI) for studies evaluating polypharmacy in PLWHA from January 2000 to August 2021 to ascertain the exact numerical threshold that defines this morbidity. Two independent reviewers extracted and reviewed relevant variables for analyses. The review included a total of 31 studies involving n = 53,347 participants with a mean age of 49.5 (SD ± 17.0) years. There was a total of 36 definitions, with 93.5% defining polypharmacy as the concomitant use of 5 or more medications. We found significant variation in the numerical definition of polypharmacy, with studies reporting it as “minor” (N = 3); “major” (N = 29); “severe” (N = 2); “excessive” (N = 1); and “higher” (N = 1). Most studies did not incorporate a duration (84%) in their definition and excluded ART medications (67.7%). A plurality of studies in PLWHA have established that polypharmacy in this cohort of patients is the intake of ≥ 5 medications (including both ART and non-ART). To standardize the approach to addressing this rising morbidity, we recommend incorporation of this definition into national and international PLWHA treatment guidelines.
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15
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Okoli C, Finkielsztejn L, Appiah A, Pugliese P, Fructuoso C, de los Rios P. Comorbidities, comedications and polypharmacy among people living with HIV and associated challenges with HIV antiretroviral therapy: Findings from people living with HIV in four countries in Western Europe. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/151521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Koga I, Wakatabe R, Okamoto N, Sasai A, Kambara K, Maldonado A, de Los Rios P, Okoli C. Factors Associated with Treatment Satisfaction Among People Living with HIV in Japan and Other Selected Countries: Examination of the Intertwined Roles of Medication, Patient, and Provider Characteristics. AIDS Behav 2022; 26:1633-1651. [PMID: 34870772 PMCID: PMC8647062 DOI: 10.1007/s10461-021-03515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
We examined satisfaction and perceived challenges with antiretroviral therapy (ART) among people living with HIV (PLHIV) in Japan vs three other Asian countries (China, Taiwan, South Korea), and 21 non-Asian countries, using data from the 2019 Positive Perspectives Study (pooled sample size from all 25 countries = 2389). Participants in other Asian countries were more likely than those in Japan to report they missed ART ≥ 1 time in the past month because they were depressed/overwhelmed (57.4%[89/155] vs 32.0%[24/75]), had privacy concerns (56.8%[88/155] vs 30.7%[23/75]), were concerned about the potential long-term negative impacts of ART (46.5%[72/155] vs 26.7%[20/75]), or just wanted to forget about HIV (45.8%[71/155] vs 22.7%[17/75]). ART satisfaction however did not differ significantly between surveyed PLHIV in Japan (54.7%[41/75]) vs those in other Asian countries (47.7%[74/155]). The percentage who felt that daily ART dosing limited their lives was 36.0%[27/75] among participants from Japan, 48.4%[75/155] among participants from other Asian countries, and 27.3%[589/2159] among those from non-Asian countries. Within a structural equation model using pooled data from all 25 countries, positive correlations were seen between ART satisfaction and "provider engagement" (β = 0.35), high perceived control over ART dosing schedule (β = 0.28), and the belief that ART prevents HIV transmission (β = 0.16). Conversely, negative correlations were seen between ART satisfaction and experience of ART side-effects (β = - 0.24), high "ART anxiety" (β = - 0.20); and being on multi-tablet regimens (β = - 0.13). Those ART-satisfied reported higher self-rated health and greater ART adherence. These findings underscore the need for patient-centered care to enhance treatment satisfaction and improve ART adherence.
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Affiliation(s)
| | | | | | | | - Keita Kambara
- Japanese Network of People Living With HIV/AIDS (JANP Plus), Tokyo, Japan
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17
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Park S, Hsiao YH, Yu F, Kambara K, Allan B, Brough G, Hwang TF, Dang N, Young B, Patel R, Maldonado A, Okoli C. Drug-drug interactions with antiretroviral therapy among people living with HIV in Asia and other regions: risk factors and impact on indicators of health-related quality of life. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/149454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Yoo-Jeong M, Anderson A, Brittany “Ray” Gannon, Schnall R. A systematic review of engagement in care and health care utilization among older adults living with HIV and non-communicable diseases. AIDS Care 2022; 34:135-144. [PMID: 34251920 PMCID: PMC8752641 DOI: 10.1080/09540121.2021.1951646] [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: 09/08/2020] [Accepted: 06/28/2021] [Indexed: 02/03/2023]
Abstract
It is critical to understand health care engagement and utilization among older persons living with HIV (OPWH) who may have greater burden for non-communicable diseases. Following the PRISMA guidelines, a systematic review using 5 electronic databases was conducted to appraise and synthesize the current literature on the relationship of non-communicable diseases on engagement in care and health care utilization among OPWH. Original studies published in English between 2009 and 2019 were included, yielding 16 relevant articles. Overall, having co-morbid non-communicable diseases was associated with a decreased likelihood of initiating and adhering to ART. Being on ART and viral suppression were associated with better engagement in non-communicable disease care. Findings also suggest that an increasing number of co-morbidities is associated with higher health care utilization and financial burden. This review underscores the need for preventing and managing co-morbidities to enhance engagement in HIV care and that health care practitioners need to ensure that OPWH are engaged in care for both HIV and their co-morbid conditions by providing coordinated and integrated care.
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Affiliation(s)
- Moka Yoo-Jeong
- Northeastern University, Bouvé College of Health Sciences, School of Nursing, Boston, Massachusetts, USA
| | - Ashley Anderson
- Columbia University School of Nursing, New York, New York, USA
| | | | - Rebecca Schnall
- Columbia University School of Nursing, New York, New York, USA
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19
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Alrasheed M, Guo JJ, Lin AC, Wigle PR, Hardee A, Hincapie AL. The effect of polypharmacy on quality of life in adult patients with nonalcoholic fatty liver disease in the United States. Qual Life Res 2022; 31:2481-2491. [DOI: 10.1007/s11136-022-03090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
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20
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Sojak L, Simekova K, Piesecka L, Wiesinger M, Jarcuska P. Attitudes and Perspectives of People Living With Human Immunodeficiency Virus: Findings From the Positive Perspectives Survey in Slovakia. Int J Public Health 2021; 66:642869. [PMID: 34744591 PMCID: PMC8565261 DOI: 10.3389/ijph.2021.642869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate the perspectives and attitudes of people living with human immunodeficiency virus (PLHIV) in Slovakia. Methods: A cross-sectional, computer-assisted web survey on health status, emotional support, stigmatisation, communication with physician, treatment, perception, decision-making, concerns, and treatment history. A representative sample of >10% of all PLHIV (N = 895) in Slovakia was invited to participate. Results: Mean age of the 117 respondents was 35.4 (±8.9) years, 52.8% had higher education, and 67.0% were in full-time employment. Most (89.4%) were receiving antiretroviral therapy (ART), and 81.8% had undetectable viral load. Most (85.1%) were satisfied with their ART, and side effects were the primary reason for switching therapies. Most (60.8%) had informed only close friends or relatives about their HIV status, only 3 (2.9%) spoke openly about it, and 60.0% hid their ART from others. Of the 31 respondents (31.6%) who experienced stigmatisation, it was primarily from dentists and other physicians who refused to treat them. Conclusion: In general, PLHIV in Slovakia receive ART and are satisfied with it. They do not speak openly about their HIV status, and some have experienced discrimination.
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Affiliation(s)
- Lubomir Sojak
- Department of Infectology and Geographical Medicine, Center for Treatment of HIV/AIDS Patients, Academic L. Derer's University Hospital, Bratislava, Slovakia
| | - Katarina Simekova
- Department of Infectology and Travel Medicine, Center for Management and Treatment of HIV, University Hospital, Martin, Slovakia
| | - Lubica Piesecka
- Infectology Clinic FSVaZ by UKF, Faculty Hospital, Nitra, Slovakia
| | | | - Pavol Jarcuska
- Department of Infectology and Travel Medicine, Center for Management and Treatment of HIV, L Pasteur University Hospital and PJ Safarik University, Kosice, Slovakia
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21
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Allan B, Drummond F, Maccarrone A, Young B, Okoli C. Quantifying unmet treatment needs among people living with HIV in Australia and other countries. POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/143160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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22
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Shared Decision Making Between Patients and Healthcare Providers and its Association with Favorable Health Outcomes Among People Living with HIV. AIDS Behav 2021; 25:1384-1395. [PMID: 32748158 PMCID: PMC7397451 DOI: 10.1007/s10461-020-02973-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We assessed patient-provider communication in HIV care; data were from the 2019 Positive Perspectives Survey of people living with HIV (PLHIV) from 25 countries (n = 2389). A significantly greater proportion of recently diagnosed individuals were interested in being involved when it comes to decisions about their HIV treatment compared with any other group (72.8% [399/548], 63.1% [576/913], and 62.6% [581/928], diagnosis year: 2017–2019, 2010–2016, and pre-2010 respectively) but reported less understanding of their treatment compared with those reporting the longest duration (66.8% [366/548], 68.6% [626/913], and 77.3% [717/928], respectively). One-third of PLHIV with salient treatment-related concerns were uncomfortable discussing with providers. Of participants who felt that their HIV medication limited their life but did not discuss their concerns with their provider (n = 203), top reasons for not discussing were: perception nothing could be done (49.3% [100/203]), provider never brought up the issue (37.9% [77/203]), and not wanting to appear difficult (30.5% [62/203]). To continue to identify and address unmet treatment needs among PLHIV, providers need to ensure that there is ongoing open dialogue.
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Physical, Emotional, and Psychosocial Challenges Associated with Daily Dosing of HIV Medications and Their Impact on Indicators of Quality of Life: Findings from the Positive Perspectives Study. AIDS Behav 2021; 25:961-972. [PMID: 33026574 PMCID: PMC7936969 DOI: 10.1007/s10461-020-03055-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
To assess challenges with daily oral antiretroviral therapy (ART), we analyzed data for 2389 participants in the 2019 Positive Perspectives survey of people living with HIV in 25 countries. ART-related challenges reported included difficulty swallowing pills (33.1% [790/2389]); stress from daily dosing routine (33.3% [795/2389]); bad memories from daily intake of HIV medication (35.1%[839/2389]), and concern “that having to take pills every day means a greater chance of revealing my HIV status to others” (37.9% [906/2389]). Individuals who felt empowered by daily oral dosing [“taking my pill(s) every day reassures me that my HIV is being kept under control”] had 69% higher odds of optimal overall health (AOR 1.69, 95% CI 1.40–2.04). Conversely, odds of optimal overall health were lower among those who felt daily pill intake “limits my day-to-day life” (AOR 0.53, 95% CI 0.44–0.64). These findings show that there is need for increased flexibility of ART delivery to meet diverse patient needs.
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Akinwunmi B, Buchenberger D, Scherzer J, Bode M, Rizzini P, Vecchio F, Roustand L, Nachbaur G, Finkielsztejn L, Chounta V, Van de Velde N. Factors associated with interest in a long-acting HIV regimen: perspectives of people living with HIV and healthcare providers in four European countries. Sex Transm Infect 2021; 97:566-573. [PMID: 33632889 DOI: 10.1136/sextrans-2020-054648] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES A novel long-acting regimen (LAR) of cabotegravir and rilpivirine for HIV treatment requires dosing every 2 months instead of daily. We assessed what proportion of people living with HIV and physicians would be interested in trying and offering LAR respectively and why. METHODS 688 people living with HIV on treatment, and 120 HIV physicians completed web-based surveys in Germany, Italy, the UK and France during 2019. Balanced description of a hypothetical LAR regarding efficacy, administration and possible side effects were provided. The hypothetical long-acting injections were assumed to be cost-neutral to current daily oral antiretrovirals. Interest of people living with HIV in trying ('very'/'highly') and physicians' willingness to offer ('definitely'/'probably') this LAR in different situations, with perceived benefits/concerns was measured. RESULTS Of people living with HIV, 65.8% were interested in trying LAR. The majority (~80%-90%) of those with unmet needs felt LAR would help, including those with strong medical needs (malabsorption and interfering gastrointestinal conditions), suboptimal adherence, confidentiality/privacy concerns and emotional burden of daily dosing. Of physicians, percentage willing to offer LAR varied situationally: strong medical need (dysphagia, 93.3%; malabsorption, 91.6%; interfering gastrointestinal issues, 90.0%; central nervous system disorders, 87.5%); suboptimal adherence (84.2%); confidentiality/privacy concerns (hiding medications, 86.6%) and convenience/lifestyle (84.2%). People living with HIV liked LAR for not having to carry pills when travelling (56.3%); physicians liked the increased patient contact (54.2%). Furthermore, 50.0% of people living with HIV perceived LAR would minimise transmission risk and improve their sexual health. The most disliked attribute was scheduling appointments (37.2%) and resource constraints (57.5%) for people living with HIV and physicians, respectively. Physicians estimated 25.7% of their patients would actually switch. CONCLUSION Providers and people living with HIV viewed the described LAR as addressing several unmet needs. Alternative treatment routes and especially LAR may improve adherence and quality of life.
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Okoli C, Van de Velde N, Allan B, Hardy WD, Corbelli GM, Muchenje M, Castellanos E, Brough G, Young B, Eremin A, Ramothwala P, McBritton M, de Los Rios P. Regional differences in perceived treatments needs and priorities in relation to antiretroviral therapy among people living with HIV in 25 countries. Prev Med 2021; 142:106372. [PMID: 33333128 DOI: 10.1016/j.ypmed.2020.106372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/21/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023]
Abstract
While geographic differences in HIV burden are well documented, less is known about regional differences in perceived treatment needs. To fill this gap, the 2019 Positive Perspectives study of people living with HIV (PLHIV) was conducted in 25 countries across Northern America, Latin America, the Asian region, Europe (EU/Schengen countries), Russia, Australia, and South Africa (n = 2389). Overall mean duration of HIV was 10.1 (SD = 9.6) years. The perception that HIV had a negative impact on day-to-day life was lowest among participants from South Africa (14.0%[25/179]) and highest among participants from the Asian region (55.2%[127/230]). Most of the regional gap in the perception that HIV had a negative impact on daily life was explained by regional differences in medication-related unmet needs, stigma, demographic factors, and comorbidities. The percentage who felt they understood their treatment was highest among participants from Australia (87.5%[105/120]) and lowest among those from Russia (62.0%[93/150]), the Asian region (62.2%[143/230]), and South Africa (62.6%[112/179]). Among participants from Northern America, Europe, and Latin America, the treatment goals with the largest absolute increase in perceived importance, from time of starting treatment to time of survey among those diagnosed for ≥1 year, were minimizing the long term impact of antiretroviral treatment and keeping the number of medicines in their antiretroviral regimen at a minimum. Tailored approaches to care of PLHIV are needed as different regions have different disease burden and treatment needs. Equitable approaches to HIV care are needed across and within regions to ensure that patients' unmet needs and preferences are addressed to improve their overall wellbeing and health-related quality of life.
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Affiliation(s)
| | | | - Brent Allan
- International Council of AIDS Service Organizations (ICASO), Toronto, Canada
| | - W David Hardy
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, MD, USA
| | | | | | | | - Garry Brough
- Positively UK, 345 City Road, London EC1V 1LR, United Kingdom
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Okoli C, Van de Velde N, Brough G, Hardy WD, Corbelli G, Allan B, Muchenje M, Castellanos E, Young B, Eremin A, Ramothwala P, de los Rios P. Differences in HIV treatment experiences, perceptions, and behaviors by gender and sexual orientation in 25 middle-income and high-income countries: Findings from the 2019 Positive Perspectives Survey. POPULATION MEDICINE 2020. [DOI: 10.18332/popmed/128600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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27
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Clark L, Karki C, Noone J, Scherzer J, Bode M, Rizzini P, Vecchio F, Roustand L, Nachbaur G, Finkielsztejn L, Chounta V, Van de Velde N. Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV. POPULATION MEDICINE 2020. [DOI: 10.18332/popmed/126632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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28
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de Los Rios P, Okoli C, Punekar Y, Allan B, Muchenje M, Castellanos E, Richman B, Corbelli GM, Hardy WD, Young B, Van de Velde N. Prevalence, determinants, and impact of suboptimal adherence to HIV medication in 25 countries. Prev Med 2020; 139:106182. [PMID: 32593732 DOI: 10.1016/j.ypmed.2020.106182] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/25/2020] [Accepted: 06/14/2020] [Indexed: 01/12/2023]
Abstract
Modern antiretroviral therapy (ART) has improved the lives of people living with HIV (PLHIV) but currently requires daily adherence. We assessed prevalence and correlates of suboptimal adherence, and measured associations with self-reported health outcomes. Data were from web-based surveys of confirmed HIV+ adults on antiretroviral treatment within 25 countries during 2019 (n = 2389). Suboptimal adherence was a report of ≥1 reason for missing ART ≥5 times within the past month. Multivariable logistic regression examined associations between suboptimal adherence and self-reported overall health and virologic suppression. Overall, 24.1% (575/2389) reported suboptimal adherence, from 10.0% (5/50) in Austria, to 62.0% (31/50) in China. The most common reasons for missing ART ≥5 times in the overall population were feeling depressed/overwhelmed (7.4%, 176/2389), trying to forget about HIV (7.0%, 168/2389), and work (6.1%, 145/2389). Correlates of suboptimal adherence included being heterosexual, <50 years old, ≤high school, having gastrointestinal treatment side effects, and privacy concerns. Odds of suboptimal overall health were 1.41 (95%CI, 1.11-1.80), 2.10 (95%CI, 1.65-2.68), and 2.55 (95%CI, 2.00-3.25) among those who reported the maximum number of times missed ART for any reason within the past month as 1, 2-4, or ≥5 times respectively, vs not missing at all. Odds of virologic nonsuppression were 1.80 (95%CI, 1.33-2.45), and 2.24 (95%CI, 1.66-3.02) for 2-4, or ≥5 times of missed ART respectively, vs not missing at all; missing for only 1 time was not significantly associated with virologic nonsuppression. Novel ART strategies designed to improve adherence along with interventions to empower PLHIV and support self-medication may improve health outcomes and quality of life.
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Affiliation(s)
| | | | | | - Brent Allan
- The International Council of AIDS Service Organizations (ICASO), Toronto, Canada
| | - Marvelous Muchenje
- ViiV Healthcare ULC, 245 Armand-Frappier Boulevard, Laval, Quebec H7V 4A7, Canada
| | | | | | | | - W David Hardy
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, MD, USA
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Khawcharoenporn T, Tanslaruk V. Does polypharmacy affect treatment outcomes of people living with HIV starting antiretroviral therapy? Int J STD AIDS 2020; 31:1195-1201. [PMID: 32928055 DOI: 10.1177/0956462420949798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Polypharmacy poses risks associated with drug-drug interactions, increased adverse effects, pill burden, poor compliance and unfavorable treatment outcomes. Whether polypharmacy affects treatment outcomes among people living with HIV (PLHIV) is largely unknown. A prospective study was conducted among PLHIV followed-up at a tertiary-care clinic of an academic medical center during January 2012 to December 2017. The clinic provided comprehensive HIV care with multidisciplinary team approach focusing on treatment adherence. Polypharmacy was defined as concurrent use of 5 or more non-antiretroviral (ARV) drugs for at least one year. Of the 248 PLHIV included, 23 (9%) received polypharmacy. PLHIV with polypharmacy were older (median age 45 vs. 36 years), were more likely to have underlying diseases (65% vs. 18%) and had lower median initial CD4 counts (40 vs. 214 cells/mm3). The rates of virologic suppression at 12 months after ARV therapy were 96% and 92% in polypharmacy and non-polypharmacy groups, respectively (P = 0.70), while the median CD4 cell count increase was higher among the non-polypharmacy group at 12 months (207 vs. 403 cells/mm3; P < 0.001). There were no differences in rates of adverse effects and experienced drug-drug interactions. Hospitalization due to HIV-related diseases within 12 months after ARV initiation [adjusted odds ratio (aOR) 11.63, P = 0.004] and lower 3-item score for ARV adherence (aOR 0.49, P = 0.01) were independently associated with failure of virologic suppression at 12 months. These findings suggest that polypharmacy did not affect the virological outcomes among our PLHIV. Patients with the characteristics associated with virological failure should be closely monitored.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,HIV/AIDS Care Unit of Thammasat University Hospital, Pathumthani, Thailand
| | - Vitsaroot Tanslaruk
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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