Polypharmacy-associated risk of hospitalisation among people ageing with and without HIV: an observational study

Abstract

Background Polypharmacy, defined as use of five or more medications concurrently, is associated with adverse health outcomes and people ageing with HIV might be at greater risk than similar uninfected individuals. We aimed to determine whether known pairwise drug interactions (KPDIs) were associated with risk of admission to hospital (hereafter referred to as hospitalisation) and medication count among people ageing with and without HIV after accounting for physiological frailty.Methods In this observational study, we collected individual-level data for participants of the Veterans Aging Cohort Study (VACS) with HIV on antiretroviral therapy (ART) and with supressed HIV-1 RNA and people without HIV who were receiving at least one prescription medication, based on active medications in the 2009 fiscal year (ie, Oct 1, 2008, to Sept 30, 2009). We identified KPDIs among these patients by linking prescription fill and refill data with data from DrugBank (version 5.0.11). We collected data on all-cause mortality and hospitalisations between Oct 1, 2009, and March 31, 2019. We compared KPDI counts using random selection and actual patterns of use across medication counts from two to 12. We created a weighted KPDI Index on the basis of the average association of each KPDI with mortality among people ageing without HIV and used nested Cox models stratified by HIV status to estimate the association between medication count and hospitalisation, with incremental adjustments for demographics, physiological frailty, and KPDI Index. Findings We collected data for 9186 people ageing with HIV and 37 930 individuals without HIV. 45 913 (97•4%) of 47 116 patients were men and the sample was predominantly aged 50-64 years (30 413 [64•6%]). Compared with a random sample of medications, real-world pattern of medication counts and combinations were associated with fiveto-six times more KPDIs (eg, for a combination of six medications, KPDI count was 1•09 in the random sample, 5•49 in the HIV-negative population, and 7•13 in the HIV-positive population). For each additional observed medication, people ageing with HIV had approximately 2•94 additional KPDIs and comparators had approximately 2•67 additional KPDIs. Adjustment for demographics, physiological frailty, and KPDI Index reduced the association between medication count and risk of hospitalisation for people ageing with HIV (hazard ratio 1•08 [95% CI 1•07-1•09] reduced to 1•06 [1•05-1•07]) and those without HIV (1•08 [1•07-1•08] reduced to 1•04 [1•03-1•05]).Interpretation For each additional medication, people ageing with HIV have more drug-drug interactions than those without HIV. Adjusting for known non-ART drug-drug interactions, each additional non-ART medication confers excess risk of hospitalisation for people ageing with HIV. Randomised trials will be needed to determine whether reducing these interactions improves outcomes.

Polypharmacy and medical intensive care unit (MICU) admission and 10-year all-cause mortality risk among hospitalized patients with and without HIV

“…This work expands on prior work that found non-ARV medication polypharmacy was associated with hospitalization and mortality [ 5 ], and that polypharmacy associations with adverse outcomes were independent of underlying medical conditions (i.e., it was not simply sicker patients take more medications) [ 5 , 23 ]. Our results suggest similar associations with increasing non-ARV medication count and serious medical illnesses leading to MICU admission.…”

Aging with HIV: Increased Risk of HIV Comorbidities in Older Adults

“…Moreover, there are still many uncertainties in treating HIV in older adults when the individual has comorbidities [ 22 ]. For example, older people with HIV have higher risks of hospitalisation due to adverse events from polypharmacy [ 30 ]. In general, older adults face additional barriers to care such as patronising and ageist communication by health care professionals, exclusion from clinical trials and low income associated with retirement [ 31 ].…”

Projection of age of individuals living with HIV and time since ART initiation in 2030: estimates for France

“…These individuals were thus exposed to the first generation of nucleoside reverse transcriptase inhibitors (AZT and D4T) and protease inhibitors, which have been associated with body morphology changes and cardiovascular diseases [ 24 , 25 ]. In addition, ART duration and time living with diagnosed HIV infection have been associated with increased risk of multimorbidity [ 7 , 9 ], but also with psychological morbidity and lower quality of life [ 26 , 27 ], which should be considered as part of integrated HIV care. To the best of our knowledge, our study is the first to project time spent since ART initiation for an HIV population.…”

“…First, age is associated with chronic conditions like non-AIDS defining cancers, cardiovascular, renal, liver, bone and neurological diseases, and HIV infection further increases the risk of these conditions [6]. Increased http://onlinelibrary.wiley.com/doi/10.1002/jia2.25986/full | https://doi.org/10.1002/jia2.25986 burden of polypharmacy and risk of drug-drug interactions with cART could, therefore, represent an upcoming issue in HIV care [7,8]. Second, ageing PLHIV will possibly need access to the assisted living facility for elderly people.…”