Potentially Inappropriate Medication Use in Older Adults (≥50 years) Living with Human Immunodeficiency Virus (HIV): A Cross-Sectional Study Polypharmacy in HIV

Main Article Content

Jacqueline McMillan
Laura Nino-Canon
Shayna Campbell
M. John Gill

Keywords

Polypharmacy; prescribing; potentially inappropriate medications; aging; Human Immunodeficiency Virus (HIV)

Abstract

Background: Polypharmacy in older persons with human immunodeficiency virus (HIV) (PWH) is asso-ciated with frailty, falls, cognitive impairment, medication nonadherence, and mortality. We characterized polypharmacy and potentially inappropriate medications (PIMs) in older PWH in Calgary, Canada.
Methods: We obtained medication reconciliation data for 951 PWH aged ≥50 years as on February 1, 2020. We defined polypharmacy as ≥5 non-antiretroviral therapy (non-ART) medications and PIMs based on the 2019 Beers criteria. We compared older (≥65 years) and younger (50–64 years) age groups, as well as shorter (<10 years) and longer (≥10 years) duration of HIV infection.
Results: The mean number of non-ART medications was greater in the older cohort compared to the younger cohort (8.4 versus 6.7, respectively; P < 0.001). Similarly, those living with HIV for >10 years were taking more non-ART medications (mean value, 6.9 non-ART medications) than those with shorter duration of diagnosed HIV infection ≤10 years (mean value, 6.1 non-ART medications) (P = 0.0168). In all 60% were taking ≥1 PIM, with a mean of 1.6 PIMs per patient. Patients living with known HIV infection for >10 years were at greater risk of PIMs (1.6 PIMs) than those with shorter duration since HIV diagnosis (i.e., ≤10 years; 1.4 PIMs) (P = 0.06). PIMs included nonsteroidal anti-inflammatory drugs, opioids, non-benzodiazepine sedatives, gabapentanoids, benzodiazepines, and antipsychotics.
Conclusion: Medication reconciliation strategies are required to minimize potentially inappropriate use of medication in older PWH.



Résumé
Contexte : La polypharmacie chez les personnes âgées infectées par le VIH est associée à la fragilité, aux chutes, aux troubles cognitifs, à la non-adhésion aux médicaments et à la mortalité. Nous avons caractérisé la polypharmacie et les médicaments potentiellement contre-indiqués (MPCI) chez les personnes âgées infectées par le VIH à Calgary (Canada).
Méthodologie : Nous avons obtenu les données sur le bilan comparatif des médicaments pour 951 personnes infectées par le VIH de 50 ans et plus au 1er février 2020. Nous avons défini la polypharmacie comme étant la prescription d’au moins cinq médicaments non antirétroviraux (non-ARV) et MPCI sur la base des critères de Beers de 2019. Nous avons comparé un groupe d’âge plus avancé (≥ 65 ans) à un groupe d’âge plus jeune (de 50 à 64 ans), de même qu’une durée d’infection par le VIH plus courte (< 10 ans) à une durée d’infection plus longue (≥ 10 ans).
Résultats : Le nombre moyen de médicaments non-ARV est plus élevé dans la cohorte plus âgée que dans la cohorte plus jeune (8,4 contre 6,7; p < 0,001). De même, les personnes infectées par le VIH depuis plus de dix ans prennent plus de médicaments non-ARV (6,9) que celles dont le diagnostic de l’infection remonte à dix ans ou moins (6,1) (P =  0,0168). Soixante pour cent des patients prennent au moins un MPCI, la moyenne étant de 1,6 MPCI par patient. Les patients infectés par le VIH depuis plus de dix ans risquent davantage de prendre des MPCI (1,6 MPCI) que ceux dont le diagnostic remonte à dix ans ou moins (1,4 MPCI) (P = 0,06). Les MPCI sont les AINS, les opioïdes, les sédatifs autres que les benzodiazépines, les gabapentinoïdes, les benzodiazépines et les antipsychotiques.
Conclusion : Les stratégies relatives au bilan comparatif des médicaments sont nécessaires pour limiter le plus possible l’utilisation de médicaments potentiellement contreindiqués chez les personnes âgées infectées par le VIH.

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