Polypharmacy and Risk of Antiretroviral Drug Interactions Among the Aging HIV-Infected Population
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Among aging HIV-infected adults, polypharmacy and its consequences have not been well-described.
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.
We used the University of Liverpool HIV drug interactions database to identify ARV/non-ARV interactions with potential for clinical significance.
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).
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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- Polypharmacy and Risk of Antiretroviral Drug Interactions Among the Aging HIV-Infected Population
Journal of General Internal Medicine
Volume 28, Issue 10 , pp 1302-1310
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- drug interactions
- Industry Sectors
- Author Affiliations
- 1. Temple University School of Pharmacy, 3307 N. Broad St., Philadelphia, PA, 19140, USA
- 2. Cerner Corporation, Vienna, VA, USA
- 3. Temple University School of Medicine, Philadelphia, PA, USA
- 4. Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- 5. Centers for Disease Control and Prevention, Atlanta, GA, USA