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Polypharmacy and Risk of Antiretroviral Drug Interactions Among the Aging HIV-Infected Population

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ABSTRACT

BACKGROUND

Among aging HIV-infected adults, polypharmacy and its consequences have not been well-described.

OBJECTIVE

To characterize the extent of polypharmacy and the risk of antiretroviral (ARV) drug interactions among persons of different ages.

DESIGN AND PARTICIPANTS

Cross-sectional analysis among patients within the HIV Outpatient Study (HOPS) cohort who were prescribed ARVs during 2006–2010.

MAIN MEASURES

We used the University of Liverpool HIV drug interactions database to identify ARV/non-ARV interactions with potential for clinical significance.

KEY RESULTS

Of 3,810 patients analyzed (median age 46 years, 34 % ≥ 50 years old) at midpoint of observation, 1,494 (39 %) patients were prescribed ≥ 5 non-ARV medications: 706 (54 %) of 1,312 patients ≥ 50 years old compared with 788 (32 %) of 2,498 patients < 50 years. During the five-year period, the number of patients who were prescribed at least one ARV/non-ARV combination that was contraindicated or had moderate or high evidence of interaction was 267 (7 %) and 1,267 (33 %), respectively. Variables independently associated with having been prescribed a contraindicated ARV/non-ARV combination included older age (adjusted odds ratio [aOR] per 10 years of age 1.17, 95 % CI 1.01–1.35), anxiety (aOR 1.78, 95 % CI 1.32–2.40), dyslipidemia (aOR 1.96, 95 % CI 1.28–2.99), higher daily non-ARV medication burden (aOR 1.13, 95 % CI 1.10–1.17), and having been prescribed a protease inhibitor (aOR 2.10, 95 % CI 1.59–2.76). Compared with patients < 50 years, older patients were more likely to have been prescribed an ARV/non-ARV combination that was contraindicated (unadjusted OR 1.44, 95 % CI 1.14–1.82), or had moderate or high evidence of interaction (unadjusted OR 1.29, 95 % CI 1.15–1.44).

CONCLUSIONS

A substantial percentage of patients were prescribed at least one ARV/non-ARV combination that was contraindicated or had potential for a clinically significant interaction. As HIV-infected patients age and experience multiple comorbidities, systematic reviews of current medications by providers may reduce risk of such exposures.

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Acknowledgements

Disclaimer

The findings and conclusions of this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Funders

The Centers for Disease Control and Prevention (CDC) supported the HOPS data collection through a contract with the Cerner Corporation. The co-authors from the CDC participated in the design of the study and the analysis and interpretation of the data and approved the final version of the manuscript.

Prior presentations

This manuscript was presented at the XIX International AIDS Conference in Washington DC, USA on July 24th, 2012.

Conflict of Interest

The authors state that they have no financial disclosures or conflicts of interest to report.

Author information

Authors and Affiliations

  1. Temple University School of Pharmacy, 3307 N. Broad St., Philadelphia, PA, 19140, USA

    Carol Holtzman PharmD

  2. Cerner Corporation, Vienna, VA, USA

    Carl Armon PhD & Kathleen Wood BSN

  3. Temple University School of Medicine, Philadelphia, PA, USA

    Ellen Tedaldi MD

  4. Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

    Joan S. Chmiel PhD

  5. Centers for Disease Control and Prevention, Atlanta, GA, USA

    Kate Buchacz PhD & John T. Brooks MD

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  1. Carol Holtzman PharmD
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  2. Carl Armon PhD
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  7. John T. Brooks MD
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, and the HOPS Investigators

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Correspondence to Carol Holtzman PharmD.

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Holtzman, C., Armon, C., Tedaldi, E. et al. Polypharmacy and Risk of Antiretroviral Drug Interactions Among the Aging HIV-Infected Population. J GEN INTERN MED 28, 1302–1310 (2013). https://doi.org/10.1007/s11606-013-2449-6

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  • DOI: https://doi.org/10.1007/s11606-013-2449-6

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