Analysis of inappropriate prescribing in elderly patients of the Swiss HIV Cohort Study reveals gender inequity

Abstract

Background The extent of inappropriate prescribing observed in geriatric medicine has not been thoroughly evaluated in people ageing with HIV. We determined the prevalence of and risk factors for inappropriate prescribing in individuals aged ≥75 years enrolled in the Swiss HIV Cohort Study. Methods Retrospective review of medical records was performed to gain more insights into non-HIV comorbidities. Inappropriate prescribing was screened using the Beers criteria, the STOPP/START criteria and the Liverpool drug–drug interactions (DDIs) database. Results For 175 included individuals, the median age was 78 years (IQR 76–81) and 71% were male. The median number of non-HIV comorbidities was 7 (IQR 5–10). The prevalence of polypharmacy and inappropriate prescribing was 66% and 67%, respectively. Overall, 40% of prescribing issues could have deleterious consequences. Prescribing issues occurred mainly with non-HIV drugs and included: incorrect dosage (26%); lack of indication (21%); prescription omission (drug not prescribed although indicated) (17%); drug not appropriate in elderly individuals (18%) and deleterious DDIs (17%). In the multivariable logistic regression, risk factors for prescribing issues were polypharmacy (OR: 2.5; 95% CI: 1.3–4.7), renal impairment (OR: 2.7; 95% CI: 1.4–5.1), treatment with CNS-active drugs (OR: 2.1; 95% CI: 1.1–3.8) and female sex (OR: 8.3; 95% CI: 2.4–28.1). Conclusions Polypharmacy and inappropriate prescribing are highly prevalent in elderly people living with HIV. Women are at higher risk than men, partly explained by sex differences in the occurrence of non-HIV comorbidities and medical care. Medication reconciliation and periodic review of prescriptions by experienced physicians could help reduce polypharmacy and inappropriate prescribing in this vulnerable, growing population.

Medication burden and clustering in people living with HIV undergoing therapeutic drug monitoring

“…[12][13][14][15] In our sample female participants living with HIV were treated with drug classes usually associated with comorbidities more prevalent in women such as thyroid disorders and, not surprisingly, less with drugs used for ischemic cardiac disease (such as antiplatelet agents) or hypertrophic prostate (such as alpha-blockers). 16 Yet the larger use of cations, antiepileptics and insulin in female participants does not have obvious explanations and requires a thorough correlation with participants' comorbidities. BMI was associated with PP in controls: higher BMI may identify patients with metabolic syndrome and often type 2 diabetes.…”

“…While age has constantly been reported as a major risk factor for PP, female gender is not usually recognized as such 12–15 . In our sample female participants living with HIV were treated with drug classes usually associated with comorbidities more prevalent in women such as thyroid disorders and, not surprisingly, less with drugs used for ischemic cardiac disease (such as antiplatelet agents) or hypertrophic prostate (such as alpha‐blockers) 16 . Yet the larger use of cations, anti‐epileptics and insulin in female participants does not have obvious explanations and requires a thorough correlation with participants' comorbidities.…”

Polypharmacy and risk of admission to hospital in people ageing with HIV: what is the contribution of drug–drug interactions?

“…Previous analyses have shown that women have more polypharmacy and medication errors. 5,6 The current study did not observe a sex difference in harm from polypharmacy; however, women comprised less than 3% of the study population, thus preventing any definitive conclusion relating to sex differences. Future studies are needed to address this uncertainty and to assess the role of frailty as a potential contributor to the risk of hospitalisation related to polypharmacy.…”

“…The finding that KPDIs explain only part of the association between polypharmacy and risk of hospitalisation should prompt future studies to investigate the role of prescribing issues other than drug-drug interactions (eg, inappropriate medication, unadjusted dosing), which were found to be common in people ageing with HIV 5 and which might also lead to adverse health outcomes. Previous analyses have shown that women have more polypharmacy and medication errors.…”

What is Polypharmacy In People Living With HIV/AIDS? A Systematic Review

“…There was a total of 36 de nitions of polypharmacy, with studies further divided based on the magnitude of polypharmacy (Table 1); minor polypharmacy (N = 3); major polypharmacy (N = 29); "severe" polypharmacy (N = 2); "excessive" polypharmacy (N = 1); "higher" polypharmacy (N = 1) (Table 2). Major 29 [2], [6], [8], [15], [17][18][19][20][21][22][23][24][25][26][27][28][29], [31][32][33][34][35][36][37][38][39][40] Severe 2 [23] [26] [39] Excessive 1 [11] Higher 1 [39] Duration of Polypharmacy Amongst the included studies, 16% (N = 5) incorporated the duration of treatment to the de nition of polypharmacy, while a signi cant proportion 84% (N = 26) only provided the numerical de nition of polypharmacy with no additional information on its duration. Gimeno-Gracia et al further strati ed drug exposure based on the following duration: greater than 1 day; greater than 90 days; and greater than 180 days [14,36].…”