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Polypharmacy Halves Odds of Nonadherence
to ART-Frailty Boosts Odds
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International Workshop on HIV and Aging, September 23-24, 2021
By Mark Mascolini for NATAP and Virology Education
Taking multiple non-HIV drugs-polypharmacy-nearly halved odds that 11,000 older US residents with HIV would not take their antiretroviral therapy (ART) drugs [1]. Yet 60% of this HIV group met the study definition of nonadherence to ART.
Researchers from the Marcus Institute for Aging Research and academic colleagues noted that much work links older age to better treatment adherence. But older people also acquire conditions that may challenge adherence, and people with HIV tend to acquire these morbidities at an earlier age than their HIV-negative counterparts. Because it remains unclear whether comorbidities influence adherence to ART, these investigators undertook a large database analysis.
The research team used the Medicare (US public insurance for older people) database to identify HIV-positive people 50 or older and continuously enrolled in Medicare from June 2014 through June 2015. They tabulated prevalent geriatric conditions in the 6 months before January 1, 2015, including dementia, depression, falls, hip fracture, sensory deficits, osteoporosis, orthostatic hypotension, urinary incontinence, and frailty. They defined polypharmacy as taking 5 or more drug classes for at least 90 days.
Nonadherence to ART meant less than 95% of days covered by at least two antiretrovirals in the 6 months after January 1, 2015. Logistic regression assessed the impact of individual geriatric conditions and total number of geriatric conditions on ART nonadherence. These analyses adjusted for age, sex, race, census region, dual eligibility for Medicaid, and multimorbidity (having 5 or more conditions diagnosed before January 1, 2015).
Of the 11,034 study participants, 6616 (60%) met the study definition of nonadherence to ART-a finding at odds with some other large studies linking older age to better ART adherence [2,3]. A higher proportion of women were nonadherent than adherent (29% vs 22%), whereas a lower proportion of men were nonadherent than adherent (71% vs 78%). A lower proportion of whites were nonadherent than adherent (38% vs 48%), while a higher proportion of blacks were nonadherent than adherent (40% vs 35%).
Logistic regression determined that polypharmacy nearly halved odds of nonadherence to ART (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.50 to 0.59). Prefrailty boosted odds of nonadherence 10% (OR 1.10, 95% CI 1.00 to 1.21), while full-out frailty hoisted odds 45% (OR 1.45, 95% CI 1.21 to 1.75). (P < 0.05 for all three associations.) Number of geriatric conditions (1, or 2 or more, versus none) did not affect chances of nonadherence.
The researchers proposed that routine clinical assessment of people with HIV should include the standard frailty phenotype [4]-and at a younger age than in people without HIV. They did not speculate on why polypharmacy lowered chances of antiretroviral nonadherence. Perhaps people who need more drugs have greater concern for their health, which drives better adherence. Or perhaps people who need more drugs get more support from health workers and family to stay on schedule with their pill taking.
References
1. Olivieri-Mui B, Shi S, Oh G, McCarthy E, Wilson I, Montano M, Kim D. Adherence to antiretroviral therapy among older people living with HIV and geriatric conditions. International Workshop on HIV and Aging, September 23-24, 2021. Abstract 12.
2. Ghidei L, Simone MJ, Salow MJ, et al. Aging, antiretrovirals, and adherence: a meta analysis of adherence among older HIV-infected individuals. Drugs Aging. 2013;30:809-819. doi: 10.1007/s40266-013-0107-7.
3. Azmach NN, Hamza TA, Husen AA. Socioeconomic and demographic statuses as determinants of adherence to antiretroviral treatment in HIV infected patients: a systematic review of the literature. Curr HIV Res. 2019;17:161-172. doi: 10.2174/1570162X17666190919130229.
4. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-156. doi: 10.1093/gerona/56.3.m146.
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