Polypharmacy, Drug-Drug Interactions, and Inappropriate Drugs: New Challenges in the Aging Population With HIV

• Published in: Open forum infectious diseases Vol. 6; no. 12; p. ofz531
• Main Authors: Courlet, Perrine, Livio, Françoise, Guidi, Monia, Cavassini, Matthias, Battegay, Manuel, Stoeckle, Marcel, Buclin, Thierry, Alves Saldanha, Susana, Csajka, Chantal, Marzolini, Catia, Decosterd, Laurent
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.12.2019
• Subjects: Major; inappropriate drugs; aging; HIV; elderly; polypharmacy; drug–drug interactions
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofz531

Antiretroviral therapy has transformed HIV infection from a deadly into a chronic condition. Aging people with HIV (PWH) are at higher risk of polypharmacy, potential drug-drug interactions (DDIs), and potentially inappropriate medications (PIMs). This study aims to compare prescribed drugs, polypharmacy, and potential DDIs between young (<65 years old) and elderly (≥65 years old) PWH. The prevalence of PIMs was assessed in elderly. PWH from 2 centers within the Swiss HIV Cohort Study were asked to fill in a form with all their current medications. Polypharmacy was defined as being on ≥5 non-HIV drugs. PIMs were evaluated using Beers criteria. Potential DDIs for the most prescribed therapeutic classes were screened with the Liverpool interaction database. Among the 996 PWH included, 122 were ≥65 years old. Polypharmacy was more frequent in the elderly group (44% vs 12%). Medications and potential DDIs differed according to the age group: cardiovascular drugs and related potential DDIs were more common in the elderly group (73% of forms included ≥1 cardiovascular drug; 11% of cardiovascular drugs involved potential DDIs), whereas central nervous system drugs were more prescribed and involved in potential DDIs in younger PWH (26%, 11%). Potential DDIs were mostly managed through dosage adjustments. PIMs were found in 31% of the elderly group. Potential DDIs remain common, and PIMs constitute an additional burden for the elderly. It is important that prescribers develop and maintain a proactive approach for the recognition and management of DDIs and other prescribing issues frequently encountered in geriatric medicine.