Background and importance HIV infection causes premature aging. As a result, there is an increase in comorbidities and therapeutic burden in these patients earlier than in the rest of the population.
Aim and objectives To evaluate the prevalence of pluripathology, polypharmacy and pharmacotherapeutic complexity in HIV patients aged over 50 years and to determine the need for optimisation of non-antiretroviral therapy.
Material and methods A cross sectional observational study was conducted (November 2019 – September 2020) in HIV patients aged over 50 years. Electronic prescription programme and clinical history were used to collect the following data: sex, age, comorbidities, antiretroviral therapy (ART) and concomitant medication. Pluripathology was defined as three or more comorbidities, and polypharmacy as six or more prescribed drugs. Pharmacotherapy complexity was determined by calculating: anticholinergic burden and the drugs involved, using the anticholinergic burden calculator programme; and relevant interactions between non-ART/ART medication (potential interaction/not coadminister), using the University of Liverpool and Lexicomp databases. Pharmaceutical interventions (PI) were performed based on criteria for optimisation of non-antiretroviral therapy from a guide for pharmacological deprescription in HIV patients, published by the Spanish AIDS Study Group (GESIDA).
Results 71 patients (69% men) with mean age of 55.1 (50–65) years were evaluated. 34 patients (47.9%) had pluripathology and 39 (54.9%) had polypharmacy, with a mean of 9.3 (6–26) drugs/patient. 37 drugs with anticholinergic burden were identified in 20 (28.2%) patients, and 10 of them (50%) had more than one anticholinergic burden drug. The most common drugs involved were chlorpromazine (15.2%), clorazepate (12.1%), paroxetine (12.1%), alprazolam (12.1%) and trazodone (9.1%).
A total of 67 interactions (16 non-ART medication/51 ART medication) were detected in 34 patients (47.9%) with a mean of 2 (1–6) interactions/patient. 49 (73.1%) were considered potential interactions and 18 (26.9% ) were not coadministered. 73 PI were performed in 40 patients (56.3%) with a mean of 1.8 (1–5) PI/patient. The main drug classes that were candidates for deprescription were: anxiolytics/sedatives (20.5%), antiulcers (13.7%), antipsychotics (9.6%), antidepressants (8.2%) and antidiabetics (8.2%).
Conclusion and relevance About half of the patients had pluripathology and polypharmacy. Pharmacotherapeutic complexity was mainly due to the number of interactions. Considering the high number of drugs identified as candidates for optimisation, more coordinated intervention would be needed to improve pharmacotherapeutic prescriptions in the HIV population.
Conflict of interest No conflict of interest
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