High rates of polypharmacy-associated adverse events seen in older people with HIV


Aging people with HIV have more drug interactions compared to those without HIV, according to the results of an observational study.

The results of an observational study revealed that for each additional drug, aging people with HIV have more drug interactions compared to people without HIV.

Results, published in Lancet Healthy Longevity, also showed that after adjusting for known drug interactions with non-antiretroviral therapy (ART), each additional non-ART drug imposes an excessive risk of hospitalization in those affected. aging with HIV, the authors explained.

Polypharmacy, generally defined as the simultaneous use of 5 or more drugs, is common in older adults in North America and Europe and is associated with hospital admission and mortality in a dose-dependent manner. response, in addition to other adverse events.

For individuals aging with HIV, polypharmacy poses many challenges as these people “typically have polypharmacy a decade earlier than uninfected people” and “have excessive physiological fragility, making them more susceptible to adverse drug effects,” the authors wrote. researchers.

The more drugs that are taken together, the greater the risk of harmful interactions with other drugs and substances. Although antiretroviral therapy prolongs survival, the drugs must be taken for life and “have an unusually high number of drug interactions,” they added.

To better understand the association between hospitalization and all known paired drug interactions (KPDIs) in this population, the researchers used data from DrugBank, which contains information on all drugs approved by the US FDA. and were last updated in 2018.

The current analysis is an extension of a previous study and includes these “aging with HIV receiving antiretroviral therapy that suppressed HIV-1 RNA and people without HIV who were receiving at least one prescription drug from the United States Veterans Health System (Virginia) during the 2009 financial year (from October 1, 2008 to September 30, 2009).

Individuals were followed until March 2019 for hospitalization and all-cause mortality, while analyzes were limited to drugs filled on a chronic basis (at least 90 consecutive days allowing for a 30-day renewal window). Researchers used the Veterans Aging Cohort Study (VACS) index 2.0 to adjust for frailty (scored from 0 to 100) with higher scores indicating a higher risk of injury mortality. physiological.

A total of 9,186 people living with HIV and 37,930 people without HIV were included in the final study; the majority of patients were male and aged 50 to 64 years.

The analyzes revealed:

  • Compared with a random sample of drugs, the actual pattern of drug count and combinations was associated with 5-6 times more KPDI (e.g., for a 6 drug combination, the KPDI count was 1.09 in the random sample, 5.49 in the negative population, and 7.13 in people living with HIV)
  • Among aging people with HIV, the median CD4 count (interquartile range) was 511 (346-720) cells / mm3
  • The number of non-ART drugs was lower in aging people with HIV than in those without (mean [SD] count, 3 [3] against 4 [3])
  • Aging people with HIV had higher scores on the VACS 2.0 index, suggesting greater physiological fragility than people without HIV (mean score, 50 [15] against 33 [11])
  • For each additional drug observed, people aging with HIV had approximately 2.94 additional KPDI and comparators had approximately 2.67 additional KPDI
  • Adjusting for demographics, physiological frailty, and the KPDI index reduced the association between the number of medications and the risk of hospitalization for aging people with HIV (HR, 1.08; 95% CI , 1.07-1.09 reduced to HR, 1.06; 95% CI, 1.05-1.07) and those without HIV (HR, 1.08; 95% CI, 1.07-1 , 08 reduced to, HR 1.04; 95% CI, 1.03-1.05)

People living with HIV also had higher hospitalization and death rates. Overall, the results suggest that “aging people with HIV may be more susceptible to damage from polypharmacy than people without HIV, both due to KPDI and other mechanisms of injury,” said authors.

In addition, they found that “when an individual took a large number of drugs, the harmful effects of polypharmacy seemed to outweigh the benefits.”

Because people living with HIV take fewer non-anti-HIV drugs than those without ART, the authors hypothesized that HIV care providers are already concerned about polypharmacy.

The measurements of the number of drugs reflected in the analysis were conservative, as they only included those delivered as part of the VA, marking a limitation under study. The nature of drug interactions is also highly variable and investigators were unable to assess interactions between alcohol or other substances. Unadjusted confusion may also have affected the results.

Future analyzes that include more female patients should be done in healthcare systems to produce more generalizable results, the researchers said.

“Sophisticated computer tools are needed to better guide drug selection and deprescribing in order to avoid excessive hospitalizations and mortality from polypharmacy,” they concluded.

Reference

AC JA, Gordon KS, Romero J, et al. Risk of hospitalization associated with polypharmacy in aging people with and without HIV: an observational study. Lancet Healthy Longev. Published online October 1, 2021. doi: 10.1016 / S2666-7568 (21) 00206-3

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