What is polypharmacy in people living with HIV/AIDS? A systematic review

Abstract

Polypharmacy in people living with HIV/AIDS (PLWHA) is a rising morbidity that exacts hefty economic burden on health budgets in addition to other adverse clinical outcomes. Despite recent advances, uncertainty remains around its exact definition in PLWHA. In this systematic review and Meta-analysis, we explored relevant databases (PUBMED, EMBASE, CROI) for studies evaluating polypharmacy in PLWHA from January 2000 to August 2021 to ascertain the exact numerical threshold that defines this morbidity. Two independent reviewers extracted and reviewed relevant variables for analyses. The review included a total of 31 studies involving n = 53,347 participants with a mean age of 49.5 (SD ± 17.0) years. There was a total of 36 definitions, with 93.5% defining polypharmacy as the concomitant use of 5 or more medications. We found significant variation in the numerical definition of polypharmacy, with studies reporting it as “minor” (N = 3); “major” (N = 29); “severe” (N = 2); “excessive” (N = 1); and “higher” (N = 1). Most studies did not incorporate a duration (84%) in their definition and excluded ART medications (67.7%). A plurality of studies in PLWHA have established that polypharmacy in this cohort of patients is the intake of ≥ 5 medications (including both ART and non-ART). To standardize the approach to addressing this rising morbidity, we recommend incorporation of this definition into national and international PLWHA treatment guidelines.

Prevalence and global trends of polypharmacy in patients with chronic liver disease: A systematic review and meta-analysis

“…[4,[19][20][21] Data from pharmaco-epidemiological studies in patients with alternative morbidities, such as people living with HIV/AIDS, have shown that among the factors that drive adverse consequences of polypharmacy include the inherent propensity of parent antiretroviral drugs to bidirectional interactions, as well as the metabolizing pathways of some of the antiretroviral drugs which are highly polymorphic and therefore prone to pharmacogenetic interactions. [22][23][24] In patients with CLD it is unlikely that the nature of underlying primary liver pathology will significantly alter the prevalence estimates of polypharmacy; as previous studies have shown that very often what principally drives the medication count in these cohorts of patients has been the rising number of drugs prescribed to manage, sometimes, inevitable complications (such as portal hypertension and its sequelae, sub-acute bacterial peritonitis, and portal hypertensive gastropathy, etc) that accompany decompensation in these patients. [5,25] However, devising intervention strategies aimed at both the identification and reduction of the risks and consequences of polypharmacy in this vulnerable population will require an unambiguous risk-stratification tool.…”

Dual trajectories of antiretroviral therapy adherence and polypharmacy in women with HIV in the United States

“…We defined polypharmacy as 5 or more medications because this threshold has been associated with poor treatment outcomes (e.g., disability, falls, frailty, and death) [ 20 ]. Furthermore, the definition has been used in most studies conducted among PWHIV to assess polypharmacy [ 21 ]. We assessed the pharmacologically active ingredients rather than the number of pills because the former is more comprehensive and can capture whether nonadherence to ART is due to pill burden or drug unintended effects.…”

Management of HIV in the older adults: Clinical and public health challenge

“…Polypharmacy is defined as the concomitant use of multiple (five or more) medications by an individual (Danjuma et al, 2022). In a study of 1258 PLWH with a mean age of 72 (SD = 4.27) years for male participants and a mean age of 71 (SD = 3.94) years for females, Guaraldi et al (2018) reported polypharmacy and multimorbidity increased with the length of time that participants had lived with HIV.…”