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Polypharmacy and Aging in People Living with HIV: 6 Years of Experience in a Multidisciplinary Outpatient Clinic

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Abstract

Background

Despite the availability of potent antiretroviral drugs, the management of human immunodeficiency virus (HIV) infection still presents some important challenges, especially in older patients who often experience age-related comorbidities and complex polypharmacy.

Objective

To describe the results of our 6 year experience with the outpatient clinic [Gestione Ambulatoriale Politerapie (GAP)] for the management of polypharmacy in people living with HIV (PLWH).

Methods

Demographic characteristics, antiretroviral regimens, and number and type of comedications were collected in all PLWH included in the database of GAP from September 2016 to September 2022. Therapies were stratified based on the number of anti-HIV drugs (dual versus triple regimens) and on the presence of pharmacokinetic boosters (ritonavir or cobicistat).

Results

A total of 556 PLWH were included in the GAP database. Overall, the enrolled patients were administered 4.2 ± 2.7 drugs (range 1–17) in addition to antiretroviral therapies. The number of comedications greatly increased with age (3.0 ± 2.2 versus 4.1 ± 2.5 versus 6.3 ± 3.2 in PLWH aged < 50 versus 50–64 versus > 65 years; p < 0.001 for all comparisons). PLWH on dual antiretroviral therapies were significantly older (58 ± 9 versus 54 ± 11 years; p < 0.001) and were concomitantly treated with more drugs (5.1 ± 3.2 versus 3.8 ± 2.5; p < 0.001) compared with those on triple therapies. A significant reduction of boosted antiretroviral regimens (53% versus 23%; p < 0.001) and in the number of comedications (4.0 ± 2.9 versus 3.1 ± 2.2 drugs; p < 0.001) was observed in the subgroup of patients (n = 198) with two GAP visits.

Conclusions

The high prevalence of polypharmacy in PLWH, especially among older adults, place these patients at high risk for clinically relevant drug–drug interactions (DDIs). A multidisciplinary approach involving physicians and clinical pharmacologists could help to optimize medication regimens associated with reduced risk.

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Authors and Affiliations

  1. Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli-Sacco University Hospital, Milan, Italy

    Dario Cattaneo & Cristina Gervasoni

  2. Department of Infectious Diseases, ASST Fatebenefratelli-Sacco University Hospital, Milan, Italy

    Dario Cattaneo, Letizia Oreni, Paola Meraviglia, Noemi Astuti, Spinello Antinori, Andrea Gori & Cristina Gervasoni

  3. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Davide Minisci

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  1. Dario Cattaneo
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Corresponding author

Correspondence to Cristina Gervasoni.

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Funding

No sources of funding were used to conduct this study or prepare the manuscript.

Conflicts of interest

We declare no competing interest for the present study. CG has received personal fees from MSD, ViiV, Gilead, and Janseen Cilag unrelated to this study. DC has received personal fees from MSD, ViiV, and Janseen Cilag unrelated to this study. All of the other authors declare that they have no potential conflict of interest.

Authors contributions

DC and CG manage the GAP clinic. DC and CG designed the research and wrote the first draft of the manuscript. PM, DM, NA, AG, SA, and CG took care of the people living with HIV. DC and LO analyzed the data.

Consent to participate

All of the patients included in the study signed an informed consent form for medical procedures/interventions performed for routine treatment purposes.

Data availability statement

Data available on reasonable request from the authors.

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Cattaneo, D., Oreni, L., Meraviglia, P. et al. Polypharmacy and Aging in People Living with HIV: 6 Years of Experience in a Multidisciplinary Outpatient Clinic. Drugs Aging 40, 665–674 (2023). https://doi.org/10.1007/s40266-023-01037-1

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