Potential prescribing issues among older HIV‐infected subjects in a Mediterranean cohort: Does the current prevalence give cause for concern?

• Published in: British journal of clinical pharmacology Vol. 87; no. 3; pp. 1310 - 1317
• Main Authors: Loste, Cora, Moltó, José, Pérez‐Álvarez, Núria, Puig, Jordi, Echeverría, Patricia, Bonjoch, Anna, Fumaz, Carmina R., Lemos, Begoña, Estany, Carla, Clotet, Bonaventura, Negredo, Eugenia
• Format: Journal Article
• Language: English
• Published: England 01.03.2021
• Subjects: Aged; antiretrovirals; Cross-Sectional Studies; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV/AIDS; Humans; Inappropriate Prescribing; medication errors; patient safety; Potentially Inappropriate Medication List; prescribing; Prevalence; HIV/AIDS; patient safety; prescribing; antiretrovirals; medication errors
• ISSN: 0306-5251; 1365-2125; 1365-2125
• DOI: 10.1111/bcp.14513

Aims To determine the prevalence of potential prescribing issues (PPI) in HIV‐infected subjects aged ≥65 years according to the Beers and STOPP/START criteria and antiretroviral drug–drug interactions (Liverpool website). Secondary objectives were to assess the concordance between Beers and STOPP/START criteria in our population, and to identify the drugs most frequently involved in PPI. Methods Cross‐sectional cohort study based on a systematic review of the electronic drug prescriptions confirmed by an interview of 91 HIV‐infected patients aged ≥65 years. Discrepancies between prescription criteria were assessed using crosstabs and compared using the χ2 test or Fisher exact test. Results The mean age was 72.1 (5.6) years, 75.8% had ≥3 comorbidities and 59.3% polypharmacy. PPI were identified in 87.9%: 71.4% by STOPP/START and 45.1% by Beers. Comparing both criteria, 56.9% of PPI by STOPP/START were detected by Beers, while 92.5% of those detected by the Beers criteria were detected by STOPP/START (P < .001). Amber/red flag interactions between antiretrovirals and comedications were found in 45.1%: 3 severe (red) in 2 patients (2.2%). The most frequent drugs involved in PPI were benzodiazepines (>30%). Cobicistat was the drug most frequently involved in potential interactions (42.2%). Conclusion The prevalence of PPI among older HIV‐infected persons gives cause for concern, as it is almost 90%. Optimization strategies, including a critical review of the treatment plan, should be implemented in clinical routine by a multidisciplinary team, in particular in patients with multiple comorbidities and polypharmacy. The STOPP/START criteria seem to detect more PPI, mainly for European populations.