Polypharmacy and Drug–Drug Interactions in People Living With Human Immunodeficiency Virus in the Region of Madrid, Spain: A Population-Based Study

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Drug–drug interactions (DDIs) that involve antiretrovirals (ARVs) tend to cause harm if unrecognized, especially in the context of comorbidity and polypharmacy.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A linkage was established between the drug dispensing registry of Madrid and the Liverpool human immunodeficiency virus (HIV) DDI database (January 2017–June 2017). Polypharmacy was defined as the use of ≥5 non-HIV medications, and DDIs were classified by a traffic-light ranking for severity.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 22 945 people living with HIV (PLWH) and 6 613 506 individuals without HIV had received medications. ARV regimens were predominantly based on integrase inhibitors (51.96%). Polypharmacy was higher in PLWH (32.94%) than individuals without HIV (22.16%; P &amp;lt; .001); this difference was consistently observed across all age strata except for individuals ≥75 years. Polypharmacy was more common in women than men in both PLWH and individuals without HIV. The prevalence of contraindicated combinations involving ARVs was 3.18%. Comedications containing corticosteroids, quetiapine, or antithrombotic agents were associated with the highest risk for red-flag DDI, and the use of raltegravir- or dolutegravir-based antiretroviral therapy was associated with an adjusted odds ratio of 0.72 (95% confidence interval, .60–.88; P = .001) for red-flag DDI.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Polypharmacy was more frequent among PLWH across all age groups except those aged ≥75 years and was more common in women. The detection of contraindicated medications in PLWH suggests a likely disconnect between hospital and community prescriptions. Switching to alternative unboosted integrase regimens should be considered for patients with risk of harm from DDIs.</jats:p> </jats:sec>

The challenge of HIV treatment in an era of polypharmacy

“…This assumption is supported by the observation that access to care, through medication insurance coverage and healthcare use, was shown to be a key driver for polypharmacy in the MACS cohort . Large cohort studies comparing the prevalence of polypharmacy in PLWH and age‐matched uninfected individuals have shown higher prevalence in infected individuals across different age categories . Of interest, differences in the prevalence of polypharmacy between PLWH and age‐matched uninfected individuals were shown to be less pronounced in older age groups (i.e.…”

“…Of interest, differences in the prevalence of polypharmacy between PLWH and age‐matched uninfected individuals were shown to be less pronounced in older age groups (i.e. 65 to 74 and ≥75 years) . This finding may be explained by the natural occurrence of age‐related chronic diseases regardless of HIV infection.…”

“…Medications implicated in polypharmacy belong mostly to drug classes used in older individuals such as cardiovascular drugs, gastro‐intestinal agents, hormone replacement therapies or antiplatelet/anticoagulant medications .…”

“…The coadministration of boosted antiretroviral drugs and potent corticosteroids is contraindicated due to the risk of developing a Cushing syndrome. Nevertheless, these drugs are being used together in clinical practice as indicated by two large independent European cohort studies . The fact that corticosteroids are administered by different routes (oral, inhalation, intra‐articular, topical) may lead to an underestimation of the risk of DDI.…”

“…In HIV medicine, the term polypharmacy most often refers to non-HIV medications given in addition to antiretroviral drugs. Polypharmacy has been shown to be common in PLWH aged ≥50 years, ranging from 15% up to 94% as reported by several HIV Cohort analyses summarized in Table 2 [34,[45][46][47][48][49][50][51][52][53][54][55][56][57]. Of interest, polypharmacy was shown to be less prevalent in the Ugandan cohort possibly due to limited access to care and/or medications [56].…”