Use of different anticholinergic scales and their correlation with anticholinergic symptom burden in a cohort of people living with HIV

Mazzitelli, Maria; Trunfio, Mattia; Coin, Alessandra; Sasset, Lolita; Farina, Jacopo; Brundu, Monica; Scaglione, Vincenzo; Devita, Maria; Sergi, Giuseppe; Cattelan, Anna M

doi:10.1093/jac/dkad348

Cited by 3 publications

(1 citation statement)

References 47 publications

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“…Additionally, the use of several drugs leads to drug interactions and possible toxicities [ 6 , 7 , 8 , 9 , 10 , 11 ]. This clinical complexity often requires a multidimensional approach and dedicated services, which have been implemented in different settings [ 6 , 8 , 12 ]. In this scenario, cardiometabolic diseases became the main cause of death, followed by non-AIDS related cancers [ 13 , 14 , 15 ].…”

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confidence: 99%

Achievement of Primary Prevention Cardiometabolic Targets in Women with HIV: An Urgent Call to Action to Pursue Cardiovascular Health

Mazzitelli,

Scaglione,

Cozzolino

et al. 2024

Viruses

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Background: Cardiometabolic health has become crucial, especially for women with HIV (WWH). We assessed the achievement of targets for hypertension, dyslipidemia, and diabetes (H/Dy/DT) in primary prevention in a WWH cohort. Methods: Cross-sectional analysis including all WWH in our clinic, excluding those who had a myocardial infarction. H/Dy/DT achievement was assessed by both EACS guidelines and individual cardiovascular risk, CVR (measured by ESC calculator), using logistic regression to evaluate differences in H/Dy/DT achievement between migrant and Italian women. Results: We included 292 WWH, 55.5% Italian and 44.5% migrant women; the median age was 50 (IQR:42–58) years, 94.5% had undetectable HIV-RNA, 55.1% had a high level of education, 27.1% were smokers, and 19.2% did regularly physical exercise. Overall, 76%, 19%, and 5% of women presented a low, a high, and a very high CVR, respectively. Among Italians, 28.4% and 6.2% women presented a high and a very high CVR, respectively. Considering migrants, 7.7% and 3.8% women presented a high and a very high CVR, respectively. Overall, among migrant women, those with a high CVR were more likely to be not at target than those with a low risk (especially for LDL-c and blood pressure among people on treatment), despite the fact that we did not detect a statistically significant difference. By contrast, migrants were more likely to achieve glycemic targets than Italians (p = 0.032). Conclusions: H/Dy/DT target achievement is suboptimal, especially in migrants. A more aggressive pharmacological treatment, also assessing adherence to medical prescriptions, and promotion of healthy lifestyle should be urgently implemented, possibly redrawing the current model of care.

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Section: Introductionmentioning

confidence: 99%

Achievement of Primary Prevention Cardiometabolic Targets in Women with HIV: An Urgent Call to Action to Pursue Cardiovascular Health

Mazzitelli,

Scaglione,

Cozzolino

et al. 2024

Viruses

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The Effects of Prescribed Medications on Depressive Symptoms and Neurocognitive Performance in People With Human Immunodeficiency Virus (HIV)

Kamkwalala,

Matthews,

Garg

et al. 2024

Clinical Infectious Diseases

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Background Alterations in brain function and structure, such as depression and neurocognitive impairment, continue to occur in people with human immunodeficiency virus (HIV, PWH) taking suppressive antiretroviral therapy (ART). The lifespan of PWH has improved but the healthspan remains worse than people without HIV, in part because of aging-related diseases. As a result, polypharmacy is common and increases the risk of drug-drug interactions and adverse reactions. Methods This cross-sectional project investigated the relationship between 7 medication-related metrics (including anticholinergic burden), depressive symptoms, and neurocognitive performance in 491 PWH at a single center in the United States. All participants were taking ART and had plasma HIV RNA ≤ 200 copies/mL. Results Participants had taken ART for a mean of 6.5 years, and most (57.6%) had CD4+ T-cells >500/µL. All 7 medication-related metrics were associated with worse global neurocognitive performance (P value <.0001 to .0087). Multivariable models confirmed that higher anticholinergic burden (P = .040) and use of benzodiazepines (P = .033), antidepressants (P = .0011), and more total medications (P = .059) were associated with more depressive symptoms (model P < .0001). Use of benzodiazepines (P = .0024) and opiates (P = .043) along with higher anticholinergic burden (P = .066) were also associated with worse neurocognitive performance. Benzodiazepine use was associated with worse performance in all domains and opiate use was associated with worse performance in processing speed, motor function, executive function, and working memory. Conclusions Use of benzodiazepines, opiates, and anticholinergic drugs contribute to cognitive and mood disorders in PWH. When possible, modifying or deprescribing medications may be beneficial.

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Polypharmacy, anticholinergic burden and drug–drug interaction assessment in people with four-class-resistant HIV: data from the PRESTIGIO registry

Mazzitelli,

Pontillo,

Clemente

et al. 2024

Journal of Antimicrobial Chemotherapy

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Objectives To evaluate polypharmacy, anticholinergic burden (ACB) and drug–drug interactions (DDIs) in people with four-class-resistant HIV (4DR-PWH). Methods We performed a cross-sectional study, including 4DR-PWH from the PRESTIGIO Registry taking at least one non-antiretroviral drug. Polypharmacy was defined as taking five or more non-antiretroviral drugs. ACB was calculated using the ACB scale: 0 = no AC effect, 1–2 = low/moderate risk, ≥3 = high AC risk. Participants’ characteristics by ACB score were compared using the Kruskal–Wallis test, and Spearman's correlation coefficient was used to assess linear relationships. DDIs were evaluated using the Liverpool database. Results Overall, 172 4DR-PLWH were evaluated: 75.6% males, median age 49.9 years (IQR = 45.6–56), 62 (27.1%) on polypharmacy, 124 (72.1%) using a boosting agent and 72 (41.8%) with four or more antiretrovirals. Based on ACB, 128 (74.45%), 33 (19.2%) and 11 (6.4%) had a no, low/moderate and high AC risk, respectively. The most common AC drugs were β-blockers (12.2%), diuretics (8.7%) and antidepressants (8.7%). The high ACB was significantly related to the number of drugs/person (r = 0.33, P < 0.0001) and the number of clinical events (r = 0.222, P = 0.004). Overall, 258 DDIs were found between antiretrovirals and co-medications in 115 (66.8%) PWH, and 14 (8.1%) PWH received contraindicated drug combinations. Conclusions In 4DR-PWH, polypharmacy, DDIs and the proportion of people with moderate/high AC burden were high. In 4DR-PWH undetectability achievement and maintenance is the priority and use of boosted PIs is common. A strict collaboration (infectious diseases specialists, virologists, pharmacologists) is needed to limit the risk of ACB and DDIs and to explore the advantages of new antiretrovirals.

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Use of different anticholinergic scales and their correlation with anticholinergic symptom burden in a cohort of people living with HIV

Cited by 3 publications

References 47 publications

Achievement of Primary Prevention Cardiometabolic Targets in Women with HIV: An Urgent Call to Action to Pursue Cardiovascular Health

Achievement of Primary Prevention Cardiometabolic Targets in Women with HIV: An Urgent Call to Action to Pursue Cardiovascular Health

The Effects of Prescribed Medications on Depressive Symptoms and Neurocognitive Performance in People With Human Immunodeficiency Virus (HIV)

Polypharmacy, anticholinergic burden and drug–drug interaction assessment in people with four-class-resistant HIV: data from the PRESTIGIO registry

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