Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population

Abstract

Background: The percentage of older HIV-positive patients is growing, with an increase in age-related comorbidities and concomitant medication.

Objectives: To quantify polypharmacy and profile types of non-antiretroviral drugs collected at community pharmacies in 2014 by HIV-positive individuals on antiretroviral therapy and to compare these findings with those of the general population.

Methods: HIV-positive patients (n=199) were compared with a group of patients from the general population (n=8,172), aged between 50 and 64 years. The factors compared were prevalence of polypharmacy (≥5 comedications with cumulative defined daily dose [DDD] per drug over 180), percentage of patients who collected each therapeutic class of drug, and median duration for each drug class (based on DDD). Results were stratified by sex.

Results: Polypharmacy was more common in HIV-positive males than in the male general population (8.9% vs 4.4%, P=0.010). Polypharmacy was also higher in HIV-positive females than in the female general population (11.3% vs 3.4%, P=0.002). Percentage of HIV-positive patients receiving analgesics, anti-infectives, gastrointestinal drugs, central nervous system (CNS) agents, and respiratory drugs was higher than in the general population, with significant differences between male populations. No differences were observed in proportion of patients receiving cardiovascular drugs. The estimated number of treatment days (median DDDs) were higher in HIV-positive males than in males from the general population for anti-infectives (32.2 vs 20.0, P<0.001) and CNS agents (238.7 vs 120.0, P=0.002). A higher percentage of HIV-positive males than males from the general population received sulfonamides (17.1% vs 1.5%, P<0.001), macrolides (37.1% vs 24.9%, P=0.020), and quinolones (34.3% vs 21.2%, P=0.009).

Conclusion: Polypharmacy is more common in HIV-positive older males and females than in similarly aged members of the general population. HIV-positive patients received more CNS drugs and anti-infectives, specifically sulfonamides, macrolides, and quinolones, but there were no differences in the percentage of patients receiving cardiovascular drugs. It is essential to investigate nonantiretroviral therapy medication use in the HIV-positive population to ensure these patients receive appropriate management.

Keywords: HIV infection; aging; polypharmacy.

Figure 1

Concomitant medication use in HIV-positive patients and general population, aged 50–64 years. Notes: (A) Males, (B) females. Use of 0, 1–4, and ≥5 prescribed concomitant medications (excluding antiretrovirals) was calculated according to 1) drugs with a DDD >1; 2) drugs with a DDD >90 (treatments lasting >90 days); and 3) drugs with a DDD >180 (treatments lasting >180 days). Abbreviations: DDD, defined daily dose; HIV, human immunodeficiency virus.

Figure 2

Use of concomitant medication by therapeutic class and sex, in HIV-positive patients and general population, aged 50–64 years. Abbreviations: CNS, central nervous system; HIV, human immunodeficiency virus.

Figure 3

Median days of treatment duration per patient (based on DDD), by therapeutic class and sex, over a 1-year period, in HIV-positive patients and general population, aged 50–64 years. Note: Treatment duration was calculated using the median of sum of the DDDs for each medication within each therapeutic class. Abbreviations: CNS, central nervous system; DDD, defined daily dose; HIV, human immunodeficiency virus.