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

Abstract

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.

Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population

“…One strength of this study is that we measured drug consumption, unlike previous studies that have provided figures based on clinical notes and patient self-reporting 16,18–20. Some studies distinguish between “polyprescription” (what the physician prescribes) and “polytherapy” (what the patient actually takes) 38.…”

Evaluating drug interactions, adverse drug reactions, and level of adherence to highly active antiretroviral therapy regimen amongst HIV-positive patients who referred to an AIDS healthcare center in Fars, southern Iran: the first multifaceted study from Iran

“…Drug-drug interactions were examined based on LexiInteract TM software, desktop version (Lexi-Comp Inc., 2008), and based on their importance were classified into five groups (A, B, C, D, X) ( Table 1) and the severity of their clinical effects were determined [15].…”

Falls among Middle-Aged Women in the Women's Interagency HIV Study

“…Current paradigms suggest that aging may be accelerated in HIV-infected individuals [1], who are more likely to have conditions associated with both aging and falls, such as cognitive impairment [2, 3], frailty syndrome [4-6], and polypharmacy [7, 8] when compared to HIV-uninfected individuals. Slow gait and poor physical performance are common in HIV-infected persons [9, 10], and accelerated gait speed decline has been reported in older HIV-infected men [11].…”