Background The increase in life expectancy in HIV +patients is associated with a rise in comorbidities and concomitant medication.
Objectives To determine the prevalence and characteristics of polypharmacy in HIV +patients in real-life clinical practice in Spain.
Material and methods Multicentre, observational, cross-sectional study. Adult HIV +patients on active antiretroviral therapy who attended a pharmaceutical care visit on the day of the preset crosscut in the participating hospitals were selected. Demographic, clinical and pharmacotherapeutic variables were collected. The primary endpoint was the presence of polypharmacy, defined as ‘simultaneous prescription of six active principles including ART’. Likewise, major polypharmacy ‘11 active principles or more’ was analysed. Patients were classified according to their polypharmacy pattern in cardiovascular, depressive-anxious, obstructive-pulmonary-disease (COPD) or mixed pattern. This required that the patient had prescribed three drugs belonging to the same pattern. ART and concomitant medication adherence was measured by two different methods. The overall complexity of the treatment was calculated using the MRCI tool (ColoradoUniversity), classifying patients in high/low complexity (high >14 points).
Each patient was assigned a pattern of comorbidity, including cardio-metabolic, psycho-geriatric, mechanical-thyroid or mixed pattern. For this, the patient had to suffer at least two pathologies framed in the same pattern.
Results 1222 patients from 81 hospitals (79% males) were included. The mean age was 47.7±10.9 and 90.% had good viroimmunologic control. The most frequently prescribed treatment was based on two-nucleoside reverse transcriptase plus an integrase inhibitor (36.6%). Regarding concomitant medication, the mean number of drugs per patient was 2.±2.7 being in treatment with antidepressants or anxiolytics 24.2%. A polypharmacy prevalence of 32.4% was determined, including 5.5% of major polypharmacy. Of the 188 patients with a polypharmacy pattern, 50.5% were cardiovascular, 34.6% anxious-depressive, 6.4% COPD and 8.5% mixed. While antidepressants and anxiolytics were the most prevalent concomitant medication, the cardiovascular polypharmacy pattern was the most common in those with polypharmacy. Overall complexity index value was 6 (IQR: 3–11), presenting 14.2% of patients a high complexity. The percentage of patients with correct ART adherence was 51.9% and concomitant 49.8%.
Conclusion The prevalence of polypharmacy was high, with a predominantly cardiovascular pattern. Patients presented a moderate pharmacotherapeutic complexity but low ART and concomitant adherence.
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