Background Pharmacotherapeutic complexity and potentially inappropriate medication (PIM) negatively affect therapeutic goals in HIV +adult patients and increase frailty and risk of falls. The POINT study carried out in Spain in 2017 alerted polypharmacy and pharmacotherapeutic complexity, and low adherence in HIV +adults.
Purpose To describe treatment complexity, fall-risk-increasing drugs (FRIDs) burden, and the presence of PIM in middle-aged and elderly HIV +patients in our clinical setting.
Material and methods Observational, cross-sectional study was conducted in the referral hospital for HIV infection of our region in April 2018. We selected patients aged ≥45 y. Exclusion criteria: no medication information available in electronic clinical history. Age, gender and active chronic medication were collected. We calculated: overall treatment complexity and complexity due to concomitant one (MRCI-E tool); FRIDs with the most consistent association with a higher risk (antipsychotics, antidepressants, benzodiazepines, loop diuretics, opioids, antiepileptics and polypharmacy, according to the Systematic Review and Meta-Analysis of the EUGMS Task and Finish Group on FRIDs); anticholinergic drug burden (DBI score); and STOPP criteria. Polypharmacy was defined as ≥5 medications. Fix-dose combinations were counted as one drug.
Results A total of 143 HIV +patients were included, all of them on antirretroviral treatment (ART), 92.3% received concomitant non-HIV drugs (non-ART). Median age: 54y (SD 7.6; range 45 to 84y) and 94 (65.7%) male. Eighty-two patients (57.3%) received ≥1 FRID (35.7%≥1 benzodiazepine), 71 (49.7%) had ≥1 anticholinergic drug and at least one STOPP criteria was detected in 55 patients (38.4%).
Conclusion The impact of non-HIV drugs on overall pharmacotherapeutic complexity, and the frequent use of PIM in patients≥45 y justifies the need for periodical reassessment of the treatment in order to optimise adequacy and benefit/risk balance.
References and/or acknowledgements POINT study.
No conflict of interest.