TITLE

Polypharmacy and Risk of Antiretroviral Drug Interactions Among the Aging HIV-Infected Population

AUTHOR(S)
Holtzman, Carol; Armon, Carl; Tedaldi, Ellen; Chmiel, Joan; Buchacz, Kate; Wood, Kathleen; Brooks, John
PUB. DATE
October 2013
SOURCE
JGIM: Journal of General Internal Medicine;Oct2013, Vol. 28 Issue 10, p1302
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
BACKGROUND: Among aging HIV-infected adults, polypharmacy and its consequences have not been well-described. OBJECTIVE: 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. MAIN MEASURES: We used the University of Liverpool HIV drug interactions database to identify ARV/non-ARV interactions with potential for clinical significance. KEY RESULTS: 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). CONCLUSIONS: 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.
ACCESSION #
90470721

 

Related Articles

  • Pharmacists as providers of HIV pre-exposure prophylaxis. Bruno, Christine; Saberi, Parya // International Journal of Clinical Pharmacy;Dec2012, Vol. 34 Issue 6, p803 

    The efficacy of HIV pre-exposure prophylaxis (PrEP) has been demonstrated in four clinical trials to date; however, the success of PrEP is largely dependent on high levels of medication adherence. Due to their extensive experience and expertise in medication adherence counseling, as well as...

  • Treatment Options for HIV-Associated Tuberculosis. Onyebujoh, Philip Chukwuka; Ribeiro, Isabela; Whalen, Christopher Curtis // Journal of Infectious Diseases;8/15/2007 Supplement, Vol. 196, pS35 

    The vicious interaction between the human immunodeficiency virus (HIV) infection and tuberculosis (TB) pandemics poses special challenges to national control programs and individual physicians. Although recommendations for the treatment of TB in HIV-infected patients do not significantly differ...

  • Prevalence and factors associated with idiopathic hypercalciuria in HIV patients on combination antiretroviral therapy. Pocaterra, D.; Carenzi, L.; Ricci, E.; Minisci, D.; Schiavini, M.; Gervasoni, C.; Meraviglia, P.; Bevilacqua, M.; Rizzardini, G.; Bonfanti, P. // International Journal of STD & AIDS;Dec2010, Vol. 21 Issue 12, p829 

    Idiopathic hypercalciuria may lead to bone loss via three pathogenic mechanisms described in HIV-negative patients: intestinal hyperabsorption, kidney loss and bone hyperabsorption. We conducted a cross-sectional study in a cohort of 217 HIV-positive antiretroviral-experienced patients,...

  • Prevalence of Dyslipidemia and Metabolic Abnormalities in HIV-Infected Patients. Ramezani, Amitis; Mohraz, Minoo; Yadegarinia, Davood; Banifazl, Mohammad; Gachkar, Latif; Jam, Sara; Aghakhani, Arezoo; Eslamifar, Ali; Yaghmaie, Farhad; Nemati, Kambiz; Velayati, Ali Akbar // Acta Medica Iranica;2009, Vol. 47 Issue 2, p83 

    Dyslipidemia has become a common problem in human immunodeficiency virus (HIV) disease, especially in patients on combination antiretroviral therapy. We investigated the prevalence of and factors associated with dyslipidemia in HIV-infected patients in Iran. In this cross-sectional study, 190...

  • Perception of Antiretroviral Generic Medicines: One-Day Survey of HIV-Infected Patients and Their Physicians in France. Jacomet, Christine; Allavena, Clotilde; Peyrol, Fleur; Pereira, Bruno; Joubert, Laurence Morand; Bagheri, Haleh; Cotte, Laurent; Garaffo, Rodolphe; Gerbaud, Laurent; Dellamonica, Pierre // PLoS ONE;Feb2015, Vol. 10 Issue 2, p1 

    Background: In the interest of cost effectiveness, switching antiretroviral brand name medications to generics is recommended in France since 2013. The study objective was to evaluate the perception of generics per se and antiretroviral generics in HIV-infected patients and their hospital...

  • High Prevalence of Poor Quality Drug Prescribing in Older Individuals: A Nationwide Report From the Italian Medicines Agency (AIFA). Onder, Graziano; Bonassi, Stefano; Abbatecola, Angela M.; Folino-Gallo, Pietro; Lapi, Francesco; Marchionni, Niccolò; Pani, Luca; Pecorelli, Sergio; Sancarlo, Daniele; Scuteri, Angelo; Trifirò, Gianluca; Vitale, Cristiana; Zuccaro, Stefano Maria; Bernabei, Roberto; Fini, Massimo // Journals of Gerontology Series A: Biological Sciences & Medical ;Apr2014, Vol. 69 Issue 4, p430 

    Background. Poor quality of drug prescribing in older persons is often associated with increased drug-related adverse events, hospitalization, and mortality. The present study describes a set of prescribing quality indicators developed by the Geriatrics Working Group of the Italian Medicines...

  • Patients' knowledge and beliefs about antiretroviral treatment and factors associated with adherence in Mpumalanga Province, South Africa. Mthembu, Thuli G.; van Wyk, Brian // Health SA Gesondheid;2014, Vol. 19 Issue 1, p1 

    Background: Antiretroviral treatment (ART) improves the prognosis and quality of life for HIV patients by reducing the rate of disease progression and mortality. Although ART has been available in public health centres in South Africa since 2003, adherence to treatment still remains a challenge....

  • High adherence to antiretrovirals in rural Uganda.  // PharmacoEconomics & Outcomes News;8/26/2006, Issue 510, p6 

    The article presents the results of a study regarding high adherence to antiretrovirals in rural Uganda. The study revealed that a home-based care programme can achieve good adherence and response to antiretroviral therapy in African patients with HIV infection. The quarterly mean pill count...

  • Adherence to anti-retroviral therapy among HIV patients in Bangalore, India. Cauldbeck, Mary B.; O'Connor, Catherine; O'Connor, Mortimer B.; Saunders, Jean A.; Rao, Bhimasena; Mallesh, V. G.; Praveen Kumar, Nagendrappa Kotehalappa; Mamtha, Gurushanthappa; McGoldrick, Claire; Laing, Robert B. S.; Satish, Kadappa Shivappa // AIDS Research & Therapy;2009, Vol. 6, Special section p1 

    Introduction: Human Immunodeficiency Virus (HIV) has an estimated prevalence of 0.9% in India (5.2 million). Anti-retroviral drugs (ARV) are the treatments of choice and non-adherence is an important factor in treatment failure and development of resistance, as well as being a powerful predictor...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics