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More than half of 75-and-older Swiss HIV group takes 5 or more non-ART drugs
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19th International Workshop on Clinical Pharmacology of Antiviral Therapy
Mark Mascolini
Among Swiss HIV Cohort Study (SHCS) members 75 or older, half had 7 or more non-HIV comorbidities and 60% took 5 or more drugs other than antiretrovirals (polypharmacy) [1]. One quarter received an inappropriate drug dose.
As people live longer on antiretroviral therapy (ART), those in their 60s and 70s make up a growing proportion of many HIV populations. SHCS researchers who conducted this study noted that comorbidities cared for by different providers can result in unsupervised polypharmacy and potentially dangerous drug-drug interactions. They conducted this study to assess prevalence of "polypharmacy, deleterious drug-drug interactions, and potentially inappropriate prescribing" in elderly SHCS members.
Participants eligible for this analysis were 75 years or older members of SHCS, an ongoing nationwide observational study. The investigators reviewed medical charts to record comorbidities and medications for each participant. They gathered sociodemographic, clinical, and lab measures from the SHCS database and defined polypharmacy as taking 5 or more non-HIV drugs.
The SHCS investigators used the Liverpool HIV drug-interaction database (https://www.hiv-druginteractions.org/) to screen for drug-drug interactions. They used Beers, STOPP/START tools, and other criteria to check for inappropriate prescribing, defined as (1) drugs administered at incorrect dosage, (2) drugs prescribed without clinical indication, (3) prescribing omission in elderly with specific medical conditions, (4) drugs not recommended in elderly, (5) deleterious drug-drug interactions between HIV and non-HIV drugs, and (6) drugs administered beyond the recommended treatment duration.
The analysis included 111 SHCS members, 81% of them men, with a median age of 78 years. The group had a median of 7 non-HIV comorbidities (interquartile range 5 to 10), the most prevalent being cardiovascular, metabolic, and musculoskeletal conditions. Six in 10 participants had 5 or more non-HIV drug prescribed (polypharmacy). While 48% took an integrase inhibitor regimen, 36% took a nonnucleoside and 28% a protease inhibitor.
Two thirds of the study group (69%) had 1 or more inappropriate prescribing problem, and 40% of those problems could have dangerous clinical consequences. The most frequent prescribing errors were inappropriate dose (25%), inappropriate indication (21%), prescription omission (19%), inappropriate drugs (19%), drug-drug interactions between HIV and non-HIV drugs (11%), drug-drug interactions involving only non-HIV drugs (2%), and inappropriate treatment duration (2%). Compared with people without polypharmacy, a significantly higher proportion with polypharmacy had more than 1 instance of inappropriate prescribing (P = 0.002).
The SHCS team called for more health worker education on principles of geriatric medicine and periodic review of prescriptions by clinical pharmacologists or pharmacists.
Reference
1. Livio F, Rrustemi F, Moffa G, et al. Polypharmacy, drug-drug interactions and potentially inappropriate prescribing in elderly patients of the Swiss HIV Cohort Study. 19th International Workshop on Clinical Pharmacology of Antiviral Therapy. May 22-24, 2018. Baltimore. Abstract 19.
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