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. 2019 Dec 21;6(12):ofz531.
doi: 10.1093/ofid/ofz531. eCollection 2019 Dec.

Polypharmacy, Drug-Drug Interactions, and Inappropriate Drugs: New Challenges in the Aging Population With HIV

Perrine Courlet  1 , Françoise Livio  1 , Monia Guidi  1   2 , Matthias Cavassini  3 , Manuel Battegay  4 , Marcel Stoeckle  4 , Thierry Buclin  1 , Susana Alves Saldanha  1 , Chantal Csajka  1   2 , Catia Marzolini  4   5 , Laurent Decosterd  1 ; Swiss HIV Cohort Study
Collaborators, Affiliations

Polypharmacy, Drug-Drug Interactions, and Inappropriate Drugs: New Challenges in the Aging Population With HIV

Perrine Courlet et al. Open Forum Infect Dis. .

Abstract

Background: Antiretroviral therapy has transformed HIV infection from a deadly into a chronic condition. Aging people with HIV (PWH) are at higher risk of polypharmacy, potential drug-drug interactions (DDIs), and potentially inappropriate medications (PIMs). This study aims to compare prescribed drugs, polypharmacy, and potential DDIs between young (<65 years old) and elderly (≥65 years old) PWH. The prevalence of PIMs was assessed in elderly.

Methods: PWH from 2 centers within the Swiss HIV Cohort Study were asked to fill in a form with all their current medications. Polypharmacy was defined as being on ≥5 non-HIV drugs. PIMs were evaluated using Beers criteria. Potential DDIs for the most prescribed therapeutic classes were screened with the Liverpool interaction database.

Results: Among the 996 PWH included, 122 were ≥65 years old. Polypharmacy was more frequent in the elderly group (44% vs 12%). Medications and potential DDIs differed according to the age group: cardiovascular drugs and related potential DDIs were more common in the elderly group (73% of forms included ≥1 cardiovascular drug; 11% of cardiovascular drugs involved potential DDIs), whereas central nervous system drugs were more prescribed and involved in potential DDIs in younger PWH (26%, 11%). Potential DDIs were mostly managed through dosage adjustments. PIMs were found in 31% of the elderly group.

Conclusions: Potential DDIs remain common, and PIMs constitute an additional burden for the elderly. It is important that prescribers develop and maintain a proactive approach for the recognition and management of DDIs and other prescribing issues frequently encountered in geriatric medicine.

Keywords: HIV; aging; drug–drug interactions; elderly; inappropriate drugs; polypharmacy.

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Figures

Figure 1.
Figure 1.
Distribution of the most prescribed antiretroviral regimens for the entire study period, stratified by age group. Abbreviations: INSTI, integrase strand transfer inhibitor; NNRTI, non-nucleoside reverse transcriptase inhibitor; PI, protease inhibitor.
Figure 2.
Figure 2.
Overall distribution of the number of prescribed comedications for the entire study period, stratified by age group.
Figure 3.
Figure 3.
Percentage of people with HIV treated with at least 1 comedication of the 4 most prescribed therapeutic classes for the entire study period, stratified by age group.
Figure 4.
Figure 4.
Percentage of prescriptions (n = 767) with at least 1 drug of the corresponding therapeutic class for the entire study period. Potential DDIs between ART and non-ART drugs are represented with different shades according to the severity of potential DDIs: red flag (deleterious), amber flag (potential clinical relevance, manageable by performing dosage adjustment or close clinical monitoring), and yellow flag (weak clinical relevance). The green flag corresponds to the absence of potential DDIs. Abbreviations: ART, antiretroviral therapy; DDI, drug–drug interaction; PDDI, potential drug–drug interaction.
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