Background and Importance Due to a higher burden of non-HIV comorbidities and the use of multiple medicines in comparison to non-infected population, older people living with HIV (PLWH) are more likely to be at risk of drug-related problems, including potentially inappropriate medications (PIMs) and potentially omitted prescriptions (PPOs).
Aim and Objectives To determine the prevalence of PIMs and PPOs in older PLWH. To identify the main groups of medications involved in PIMs and PPOs according to the STOPP-START criteria.
Material and Methods A cross-sectional, observational, multicentre study was conducted. Older PLWH (aged 65 or older) who were on active antiretroviral treatment at four different hospitals between 1 September 2021 and 31 December 2021 were included. Demographic and clinical-pharmacotherapeutic data were obtained from electronic medical records. A comprehensive medication review was conducted by a hospital pharmacist. PIMs and PPOs were identified using the STOPP-START criteria.
Results One hundred patients were included, 83% male, mean age 73.1 years (SD 6), mean VACS index 40.8 (SD 11), 96% were multipathological (mean number of non-HIV comorbidities 4.3, SD 2). Mean number of chronic drugs per patient (excluding antiretroviral treatment), 8.5 (SD 3.4), 92% presented polypharmacy. For the patients included, a total of 124 PIMs and 119 PPOs were identified. The global prevalence of PIMs and PPOs was 75%. The prevalence of PIMs and PPOs separately was 53% and 68% respectively. Seventeen different STOPP criteria were identified. The most frequent STOPP criteria were A1 (drug without evidence-based clinical indication, n= 51, 41.1%), D5 (benzodiazepines for 4 or more weeks, n=20, 16.1%) and K1-K4 (benzodiazepines and Z-drug prescriptions, n=20, 16.1%). Twenty different START criteria were identified. The most frequent START criteria were I1-I2 (influenza and pneumococcal vaccine, n=56, 47%), E4 (bone antiresorptive or anabolic therapy in osteoporosis, n=10, 8.4%) and G8 (5-alpha reductase inhibitor with symptomatic prostatism, n=8, 6.7%).
Conclusion and Relevance Three quarters of the patients included in our cohort of older PLWH present PIMs or PPOs. The main group of drugs involved in PIMs and PPOs are benzodiazepines and vaccines. Medication review is essential to optimise pharmacotherapy and prevent drug related problems in this population.
References and/or Acknowledgements STOPP-START criteria (O’Mahony et al., 2015). PMID 25324330
Conflict of Interest No conflict of interest
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