Polypharmacy and Aging in People Living with HIV: 6 Years of Experience in a Multidisciplinary Outpatient Clinic

Cattaneo, Dario; Oreni, Letizia; Meraviglia, Paola; Minisci, Davide; Astuti, Noemi; Antinori, Spinello; Gori, Andrea; Gervasoni, Cristina

doi:10.1007/s40266-023-01037-1

Cited by 12 publications

(11 citation statements)

References 51 publications

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“…On the other hand, as expected, we found a higher percentage of DDIs in PLWH. Since 2012, several articles have been published dealing with the high prevalence of interactions in this population in any age group, except 75 years, and how it increases in polymedicated patients 9 13. In our case, we can explain that the risk of DDIs is higher because the evaluation of potential DDIs may overestimate the rates of actual DDIs causing harm to the patient, as not all potential DDIs necessarily translate into actual harm 24…”

Section: Discussionmentioning

confidence: 79%

“…All this has led to an increase in the pharmacotherapeutic complexity of patients who require a management approach that involves optimising medication regimens associated with risk reduction 13. Following this line, the 3-HIT concept was developed and analysed in PLWH, which was defined as the presence of high pharmacotherapeutic complexity, DDIs and NAC in polymedicated patients 14.…”

Section: Introductionmentioning

confidence: 99%

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Comparative analysis of the prevalence 3-HIT concept in people living with HIV and seronegative patients with chronic conditions. Cross-3HIT Project.

Contreras Macías,

Espina Lozano,

Cantudo-Cuenca

et al. 2024

Eur J Hosp Pharm

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ObjectivesThis study aimed to assess and compare the occurrence of 3-HIT in people living with HIV (PLWH) and seronegative patients. Additionally, the study investigated whether HIV infection could serve as a predictor of the presence of 3-HIT.MethodsA cross-sectional study was conducted between December 2022 and January 2023 to compare PLWH with a group of seronegative patients with chronic diseases attending an outpatient hospital pharmacy service. The 3-HIT concept encompasses the simultaneous presence of non-adherence to concomitant treatment (NAC), drug–drug interactions (DDIs), and high pharmacotherapeutic complexity in polymedicated patients. The assessment of 3-HIT compliance included NAC, evaluated using both the Morisky-Green questionnaire and electronic pharmacy dispensing records. DDIs were analysed using the Liverpool University and Micromedex databases. Pharmacotherapeutic complexity was measured using the Medication Regimen Complexity Index (MRCI) tool. Logistic regression analysis was performed to identify independent factors related to 3-HIT. Additionally, an explanatory logistic model was created to investigate whether HIV infection, along with other adjustment variables, could predict compliance with the 3-HIT concept.ResultsThe study included 145 patients: 75 PLWH and 70 seronegative patients. The median age was 40 versus 39 years, respectively (p=0.22). Seronegative patients exhibited a higher prevalence of NAC (p<0.01). HIV infection was identified as a protective factor in the context of DDIs (p<0.01). Male sex (p<0.01) and age (p=0.01) were identified as being associated with an MRCI ≥11.25 points. A higher prevalence of 3-HIT was observed in seronegative patients (18.7% vs 48.6%, p<0.01). However, the developed regression model identified HIV infection as a risk factor associated with an increased likelihood of 3-HIT (OR 4.00, 95% CI 1.88 to 8.52, p<0.01).ConclusionsThe 3-HIT concept exhibited a high prevalence among seronegative patients with chronic diseases, with HIV infection identified as a predicted risk factor for NAC and the development of 3-HIT.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Comparative analysis of the prevalence 3-HIT concept in people living with HIV and seronegative patients with chronic conditions. Cross-3HIT Project.

Contreras Macías,

Espina Lozano,

Cantudo-Cuenca

et al. 2024

Eur J Hosp Pharm

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“…In conclusion, this case highlights the importance of a multidisciplinary service that includes a clinical pharmacologist and TDM of both antiretroviral and nonantiretroviral comedications for the optimal management of polypharmacy in people living with HIV. 14…”

Section: Discussionmentioning

confidence: 99%

Effect of Carbamazepine on Darunavir Trough Concentrations: When the Dose Can Make the Difference—A Case Study

Cattaneo,

Caloni,

Caronni

et al. 2024

Therapeutic Drug Monitoring

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Background: Carbamazepine (CBZ) is an antiseizure medication known to induce the expression of cytochrome P4503A metabolic enzymes. Here, we describe a man living with HIV who underwent several changes in the daily dose of CBZ, which resulted in different induction effects on darunavir trough concentrations. Methods: A 59-year-old man with HIV, successfully undergoing maintenance antiretroviral treatment with darunavir/cobicistat once daily (combined with raltegravir), was prescribed CBZ for recurrent trigeminal neuralgia. Over subsequent months, the patient underwent various changes in the doses (from 200 to 800 mg/d) and trough concentrations (from 3.6 to 18.0 mg/L) of CBZ, guided by clinical response to trigeminal neuralgia. Results: A highly significant inverse association was observed between darunavir trough concentration and both CBZ dose or trough concentration (coefficient of determination >0.75, P < 0.0001). Ultimately, the darunavir dose was increased to 600 mg twice daily with ritonavir and dolutegravir to ensure optimal antiretroviral coverage, anticipating potential further uptitration of CBZ doses. Conclusions: The impact of CBZ on boosted darunavir exposure seemed to be dose- and concentration-dependent. The management of such drug–drug interactions in daily practice was facilitated through therapeutic drug monitoring. This case underscores the importance of a multidisciplinary approach that incorporates both antiretroviral and nonantiretroviral comedications contributing to the optimal management of polypharmacy in individuals living with HIV.

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“…19,22,[27][28][29][30] In general, a large proportion of PLHIV use benzodiazepines over a long time, 29,31 contraindicated nonsteroidal anti-inflammatory agents, 32 have a high burden of anticholinergic or sedative medications, 27,33 and suffer from a lack of prescription of calcium and vitamin D, 30,32 some vaccines, 32 or cardiovascular agents in PLHIV at risk, 30 among others. Although ART has been reduced to the minimum possible difficulty (ie, a daily tablet), 34 pharmacotherapeutic complexity of the comedication, PIMs, and polypharmacy remain a problem to solve.…”

Section: Introductionmentioning

confidence: 99%

Potentially Inappropriate Prescribing in Older People Living With HIV: A Scoping Review

Vélez-Díaz-Pallarés,

Delgado-Silveira,

Fernández-Fradejas

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Antiretroviral therapy has transformed HIV from a progressive and often fatal infection to a chronic disease. Currently, people living with HIV (PLHIV) have near-normal life expectancy; however, they face accelerated ageing and a rise in non-AIDS-defining HIV-associated conditions. Comorbidities increase the number of prescribed drugs and, therefore, the risk of polypharmacy and prescribing potentially inappropriate medications (PIMs). Still, there are no specific tools to identify PIMs in older PLHIV, which opens a pathway to investigate the particularities in the prescription of medication in this population. Methods: We conducted a scoping review in five electronic databases for studies reporting the use of tools to identify PIMs in older PLHIV. No language or date restrictions were applied. To complete the search, abstracts published in the most relevant HIV Conferences and Events in their editions from 2010-2022 were screened. Results: Of 50,193 records returned (13,701 of the databases and 36,492 of the Congresses), 39 studies met the inclusion criteria. Most studies were single-centre and conducted in Europe. Twenty-eight studies were cross-sectional, and most researchers used explicit criteria, mainly Beers and STOPP-START criteria, to identify PIMs. Conclusions: Potentially inappropriate prescribing is frequent amongst older PLHIV. Explicit conventional tools to identify PIMs in older populations may need to be adapted to tackle the needs of PLHIV. Implicit tools may be more valid, although their use is more time-consuming, and standardization is complex.

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Polypharmacy and Aging in People Living with HIV: 6 Years of Experience in a Multidisciplinary Outpatient Clinic

Cited by 12 publications

References 51 publications

Comparative analysis of the prevalence 3-HIT concept in people living with HIV and seronegative patients with chronic conditions. Cross-3HIT Project.

Comparative analysis of the prevalence 3-HIT concept in people living with HIV and seronegative patients with chronic conditions. Cross-3HIT Project.

Effect of Carbamazepine on Darunavir Trough Concentrations: When the Dose Can Make the Difference—A Case Study

Potentially Inappropriate Prescribing in Older People Living With HIV: A Scoping Review

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