Pill Burden in HIV Infection: 20 Years of Experience

Krentz, Hartmut B.; Cosman, Ian; Lee, Kathy; Ming, Jinell Mah; Gill, M John

doi:10.3851/imp2076

Cited by 48 publications

(49 citation statements)

References 39 publications

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“…Advances in combination antiretroviral therapy have resulted in single combination pills, which has improved adherence to therapy, however overall pill burden has not changed due to the non-HIV medication pill burden. 11 …”

Section: Introductionmentioning

confidence: 99%

Polypharmacy, Drug–Drug Interactions, and Potentially Inappropriate Medications in Older Adults with Human Immunodeficiency Virus Infection

Greene

Steinman

McNicholl

et al. 2014

J American Geriatrics Society

141

121

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Objectives To describe the frequency of medication-related problems in older HIV-infected adults Design Retrospective chart review Setting And Participants Community dwelling HIV-infected adults age 60 and older and age and sex-matched HIV-uninfected adults Measurements Total number of medications, potentially inappropriate medications as defined by the modified Beers criteria, anticholinergic drug burden as defined by the Anticholinergic Risk Scale, and drug-drug interactions using Lexi-Interact online drug interactions database. Results Of 89 HIV-infected participants, most were Caucasian (91%) and male (94%) with a median age of 64 (range 60-82). Common comorbidities included hyperlipidemia, hypertension, and depression. Participants were taking a median of 13 medications (range 2-38), of which only a median of 4 were antiretrovirals. At least one potentially inappropriate medication was prescribed in 46 participants (52%). Sixty-two (70%) participants had at least one Category D (consider therapy modification) drug-drug interaction and 10 (11%) had a Category X (avoid combination) interaction. One-third of these interactions were between two non-antiretroviral medications. We identified 15 participants (17%) with an anticholinergic risk scale score ≥3. In contrast, HIV-uninfected participants were taking a median of 6 medications, 29% had at least one potentially inappropriate medication, and 4% had an anticholinergic risk scale score ≥ 3 (p-value <0.05 for each comparison except p=0.07 for anticholinergic burden). Conclusion HIV-infected older adults have a high frequency of medication-related problems, of which a large portion is due to medications used to treat comorbid diseases. These medication issues were substantially higher than HIV-uninfected participants. Attention to the principles of geriatric prescribing is needed as this population ages in order to minimize complications from multiple medication use.

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Section: Introductionmentioning

confidence: 99%

Polypharmacy, Drug–Drug Interactions, and Potentially Inappropriate Medications in Older Adults with Human Immunodeficiency Virus Infection

Greene

Steinman

McNicholl

et al. 2014

J American Geriatrics Society

141

121

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“…2,[34][35][36] Therefore, we sought to examine the potential impact of polypharmacy on the risk of drug-drug interactions between ARVs and other medications (ARV/non-ARV interactions) in a US cohort of HIV-infected adults seen in the outpatient setting. In particular, we aimed to characterize the extent of polypharmacy, determine the types of medication classes prescribed and rate of prescribed ARV/ non-ARV combinations with the potential for clinically significant interactions among persons of different ages, and identify risk factors for such exposures.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] With continued use of ARV therapy and maintenance of long-term adherence, HIV becomes a chronic and manageable condition. 2,5 As persons infected with HIV live longer, the percentage of older individuals in the HIV-infected population has increased. In the United States (US) in 2009, persons aged 50 years and older accounted for 33 % of all individuals living with HIV/ AIDS, nearly double the 17 % reported for 2001.…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy and Risk of Antiretroviral Drug Interactions Among the Aging HIV-Infected Population

et al. 2013

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BACKGROUND: Among aging HIV-infected adults, polypharmacy and its consequences have not been welldescribed. OBJECTIVE: To characterize the extent of polypharmacy and the risk of antiretroviral (ARV) drug interactions among persons of different ages. DESIGN AND PARTICIPANTS: Cross-sectional analysis among patients within the HIV Outpatient Study (HOPS) cohort who were prescribed ARVs during 2006-2010. MAIN MEASURES: We used the University of Liverpool HIV drug interactions database to identify ARV/non-ARV interactions with potential for clinical significance. KEY RESULTS: Of 3,810 patients analyzed (median age 46 years, 34 % ≥ 50 years old) at midpoint of observation, 1,494 (39 %) patients were prescribed ≥ 5 non-ARV medications: 706 (54 %) of 1,312 patients ≥ 50 years old compared with 788 (32 %) of 2,498 patients < 50 years. During the five-year period, the number of patients who were prescribed at least one ARV/non-ARV combination that was contraindicated or had moderate or high evidence of interaction was 267 (7 %) and 1,267 (33 %), respectively. Variables independently associated with having been prescribed a contraindicated ARV/non-ARV combination included older age (adjusted odds ratio [aOR] per 10 years of age 1.17, 95 % CI 1.01-1.35), anxiety (aOR 1.78, 95 % CI 1.32-2.40), dyslipidemia (aOR 1.96, 95 % CI 1.28-2.99), higher daily non-ARV medication burden (aOR 1.13, 95 % CI 1.10-1.17), and having been prescribed a protease inhibitor (aOR 2.10, 95 % CI 1.59-2.76). Compared with patients < 50 years, older patients were more likely to have been prescribed an ARV/non-ARV combination that was contraindicated (unadjusted OR 1.44, 95 % CI 1.14-1.82), or had moderate or high evidence of interaction (unadjusted OR 1.29, 95 % CI 1.15-1.44). CONCLUSIONS: A substantial percentage of patients were prescribed at least one ARV/non-ARV combination that was contraindicated or had potential for a clinically significant interaction. As HIV-infected patients age and experience multiple comorbidities, systematic reviews of current medications by providers may reduce risk of such exposures.

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“…This increased number of older HIV-infected adults is in part due to enhanced longevity secondary to the increasingly widespread use and effectiveness of combined antiretroviral therapies (cART), as well as higher incidence rates in this age range (Centers for Disease Control and Prevention, 2015). Older age in the context of HIV infection is associated with a higher likelihood of having HIV-associated, Non-AIDS conditions (e.g., cardiovascular disease) and other medical comorbidities (e.g., diabetes), which has given rise to a commensurate increase in the number of medications prescribed to older HIV-infected adults (Krentz, Cosman, Lee, Ming, & Gill, 2012). Older HIV-infected adults are estimated to take more than seven total medications per day (Krentz et al, 2012), which is considerably higher than their younger HIV-infected (Zhou et al, 2014) and older uninfected counterparts (Lee et al, 2012).…”

mentioning

confidence: 99%

“…Older age in the context of HIV infection is associated with a higher likelihood of having HIV-associated, Non-AIDS conditions (e.g., cardiovascular disease) and other medical comorbidities (e.g., diabetes), which has given rise to a commensurate increase in the number of medications prescribed to older HIV-infected adults (Krentz, Cosman, Lee, Ming, & Gill, 2012). Older HIV-infected adults are estimated to take more than seven total medications per day (Krentz et al, 2012), which is considerably higher than their younger HIV-infected (Zhou et al, 2014) and older uninfected counterparts (Lee et al, 2012). The increase in medication burden for older HIV-infected adults has sparked concerns about undue polypharmacy and subsequent risks of non-adherence (Nachega, Hsu, Uthman, Spinewine, & Pham, 2012).…”

mentioning

confidence: 99%

Pill Burden Influences the Association Between Time-Based Prospective Memory and Antiretroviral Therapy Adherence in Younger But Not Older HIV-Infected Adults

Sheppard

Weber

Casaletto

et al. 2016

Journal of the Association of Nurses in AIDS Care

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Prospective memory (PM) is associated with antiretroviral (ARV) adherence in HIV, but little is known about how pill burden and age might affect this association. 117 older (≥ 50 years) and 82 younger (< 50 years) HIV-infected adults were administered a measure of PM in the laboratory and subsequently were monitored for ARV adherence for 30 days using the Medication Event Monitoring System. In the older group, better time-based PM performance was associated with higher likelihood of adherence, irrespective of pill burden. Within the younger sample, time-based PM was positively related to adherence only in participants with lower pill burdens. Younger HIV-infected individuals with higher pill burdens may overcome the normal effects of time-based PM on adherence through compensatory medication taking strategies, while suboptimal use of these strategies by younger HIV-infected individuals with lower pill burdens may heighten their risk of ARV non-adherence secondary to deficits in time-based PM.

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Pill Burden in HIV Infection: 20 Years of Experience

Cited by 48 publications

References 39 publications

Polypharmacy, Drug–Drug Interactions, and Potentially Inappropriate Medications in Older Adults with Human Immunodeficiency Virus Infection

Polypharmacy, Drug–Drug Interactions, and Potentially Inappropriate Medications in Older Adults with Human Immunodeficiency Virus Infection

Polypharmacy and Risk of Antiretroviral Drug Interactions Among the Aging HIV-Infected Population

Pill Burden Influences the Association Between Time-Based Prospective Memory and Antiretroviral Therapy Adherence in Younger But Not Older HIV-Infected Adults

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