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Polypharmacy in One Third of Big
HIV Cohort vs One Fifth of Non-HIV Group
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HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow
Mark Mascolini
One third of 22,945 antiretroviral-treated people in the Madrid area took 5 or more nonantiretrovirals, a pattern called polypharmacy [1]. In contrast, only one fifth of 6.6 million HIV-negative people in the area relied on polypharmacy. About 3% of the HIV group took contraindicated drug combinations according to the University of Liverpool database [2].
As people live longer with HIV, they acquire more comorbidities that require drug therapy. Eventually a substantial fraction of people taking antiretrovirals also takes 5 or more other drugs. Madrid-area researchers conducted this broad analysis to chart polypharmacy rates and to define drug-drug interactions in people with and without HIV infection.
The analysis relied on drug-dispensation records of community and hospital pharmacies in the Madrid Regional Health Service from January 1 through June 30, 2017. Researchers identified and ranked potential drug-drug interactions through an interface connecting the Madrid pharmacy database to the University of Liverpool antiretroviral-interaction charts [2].
The analysis involved 22,945 people with HIV and 6,613,506 without HIV. Overall, polypharmacy affected a significantly greater proportion of people with than without HIV, 32.9% versus 22.2% (P < 0.001). In every age group analyzed, a higher proportion of people with HIV met polypharmacy criteria, and this difference from the non-HIV group was statistically significant for every age group except people 75 or older. For people 50 to 64 years old, polypharmacy rates were 44.5% with HIV and 29% without HIV (P < 0.001), and for people 65 to 74 years old, respective rates were 62.4% and 56.8% (P < 0.001). Polypharmacy affected 80% of HIV-positive people 75 or older.
Among HIV-positive adults 18 to 50 years old, the most frequently prescribed comedications were central nervous system (CNS) drugs, antiinfectives, and gastrointestinal drugs. Among HIV-positive adults older than 50, the most frequently used comedications were CNS drugs, gastrointestinal drugs, and cardiovascular drugs.
Among all people with HIV, the Liverpool system rated 51.5% of drug-drug interactions as safe, 10.3% as weak potential interaction, 18.3% as potential interactions requiring dose modification or increased monitoring, and 3.2% as contraindicated. Among contraindicated interactions, most involved boosted protease inhibitors (2.7%), nonnucleosides (0.4%), and boosted elvitegravir (0.2%). The top 6 antiretroviral-related contraindications involved boosted darunavir (usually with nasal, inhaled, or dermatologic corticosteroids, or with antipsychotics, domperidone for nausea and vomiting, or antithrombotics. The comedications most often involved in contraindicated interactions were corticosteroids for the respiratory system (1.4%) and dermatologic indications (0.5%), antipsychotics (0.5%), statins (0.4%), imidazole antifungals, and antifungal triazole derivatives.
References
1. Lopez-Centeno B, Badenes-Olmedo C, Mataix-Sanjuan A, et al. Polypharmacy and drug-drug interactions in HIV-infected subjects in the region of Madrid (Spain): a population-based study. HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow. Abstract P211.
2. University of Liverpool. HIV Drug Interactions. https://www.hiv-druginteractions.org/
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