Deprescribing of non-antiretroviral therapy in HIV-infected patients

• Published in: European journal of clinical pharmacology Vol. 76; no. 3; pp. 305 - 318
• Main Authors: Blanco, José-Ramón, Morillo, Ramón, Abril, Vicente, Escobar, Ismael, Bernal, Enrique, Folguera, Carlos, Brañas, Fátima, Gimeno, Mercedes, Ibarra, Olatz, Iribarren, José-Antonio, Lázaro, Alicia, Mariño, Ana, Martín, María-Teresa, Martinez, Esteban, Ortega, Luis, Olalla, Julian, Robustillo, Aguas, Sanchez-Conde, Matilde, Rodriguez, Miguel-Angel, de la Torre, Javier, Sanchez-Rubio, Javier, Tuset, Montse
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2020; Springer Nature B.V
• Subjects: Aging; Anticholinergics; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biomedical and Life Sciences; Biomedicine; Drug development; Drug therapy; HIV; Human immunodeficiency virus; Life span; Pharmacology/Toxicology; Polypharmacy; Review; Aging; Non-antiretroviral therpy; Polypharmacy; Deprescriptions; HIV infection
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-019-02785-z

Purpose In recent decades, the life expectancy of HIV-infected patients has increased considerably, to the extent that the disease can now be considered chronic. In this context of progressive aging, HIV-infected persons have a greater prevalence of comorbid conditions. Consequently, they usually take more non-antiretroviral drugs, and their drug therapy are more complex. This supposes a greater risk of drug interactions, of hospitalization, falls, and death. In the last years, deprescribing has gained attention as a means to rationalize medication use. Methods Review of the different therapeutic approach that includes optimization of polypharmacy and control and reduction of potentially inappropriate prescription. Results There are several protocols for systematizing the deprescribing process. The most widely used tool is the Medication Regimen Complexity Index , an index validated in HIV-infected persons. Anticholinergic medications are the agents that have been most associated with major adverse effects so, various scales have been employed to measure it. Other tools should be employed to detect and prevent the use of potentially inappropriate drugs. Prioritization of candidates should be based, among others, on drugs that should always be avoided and drugs with no justified indication. Conclusions The deprescribing process shared by professionals and patients definitively would improve management of treatment in this population. Because polypharmacy in HIV-infected patients show that a considerable percentage of patients could be candidates for deprescribing, we must understand the importance of deprescribing and that HIV-infected persons should be a priority group. This process would be highly feasible and effective in HIV-infected persons.