Polypharmacy, Drug-drug Interactions, and Potentially Inappropriate Medications in Older Adults with Human Immunodeficiency Virus Infection

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2014 Mar 1

PMID 24576251

Citations 72

Authors

Meredith Greene

Michael A Steinman

Ian R McNicholl

Victor Valcour

Affiliations

Soon will be listed here.

Abstract

Objectives: To describe the frequency of medication-related problems in older adults with human immunodeficiency virus (HIV) infection.

Design: Retrospective chart review.

Setting: Community.

Participants: HIV-positive individuals aged 60 and older and age- and sex-matched HIV-negative individuals.

Measurements: Total number of medications, potentially inappropriate medications (PIMs) according to the modified Beers Criteria, anticholinergic drug burden according to the Anticholinergic Risk Scale (ARS), and drug-drug interactions using the Lexi-Interact online drug interactions database.

Results: Of 89 HIV-positive participants, most were Caucasian (91%) and male (94%), with a median age of 64 (range 60-82). Common comorbidities included hyperlipidemia, hypertension, and depression. Participants were taking a median of 13 medications (range 2-38), of which only a median of four were antiretrovirals. At least one PIM was prescribed in 46 participants (52%). Sixty-two (70%) participants had at least one Category D (consider therapy modification) drug-drug interaction, and 10 (11%) had a Category X (avoid combination) interaction. One-third of these interactions were between two nonantiretroviral medications. Fifteen participants (17%) had an ARS score of 3 or greater. In contrast, HIV-negative participants were taking a median of six medications, 29% had at least one PIM, and 4% had an ARS score of 3 or greater (P < .05 for each comparison, except P = .07 for anticholinergic burden).

Conclusion: HIV-positive older adults have a high frequency of medication-related problems, of which a large portion is due to medications used to treat comorbid diseases. These medication issues were substantially higher than HIV-negative participants. Attention to the principles of geriatric prescribing is needed as this population ages in order to minimize complications from multiple medication use.

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