Abstract
The effectiveness of antiretroviral therapy has significantly improved life expectancy of HIV-infected individuals. Global campaigns and awareness programmes have led to substantial drop in the rate of new infections. Consequently, the proportion of ageing HIV-infected individuals continues to increase. HIV-associated and age-related comorbidity necessitates polypharmacy in ageing individuals living with HIV/AIDS. The risk of drug-drug interaction increases with the number of administered drugs. Age-related changes in the body physiology are known to influence pharmacokinetic and pharmacodynamic profile of administered drugs. These changes include reduction in blood flow to major organs, decline in metabolic activities, body mass shrinking and changes in body water and fat proportion. These factors contribute to the perceived and reported higher incidence of drug-drug interaction in this population. The current paper reviews the reported incidence of drug-drug interactions in ageing HIV-infected individuals, providing relative mechanisms and possible factors responsible in comparison to younger population. Health professionals should be aware of the drug interaction risks involved in the management of HIV/AIDS in the ageing population; be able to anticipate them based on concomitant medications and manage them as necessary. Key words: Drug-drug interaction, drug metabolism, drugs, ageing, HIV/AIDS, cytochrome P450.
Highlights
Since the advent of highly active antiretroviral therapy (HAART) in 1990s, the management of HIV has resulted in improved quality of life, survival and life expectancy of infected individuals (Antiretroviral Therapy Cohort Collaboration, 2008; van Sighem et al, 2010; Mills et al, 2011; Nakagawa et al, 2012)
Health professionals should be aware of the drug interaction risks involved in the management of HIV/AIDS in the ageing population; be able to anticipate them based on concomitant medications and manage them as necessary
This paper provides concise review of the known factors that play significant roles in the perceived and reported higher incidences of drug-drug interaction in ageing individuals
Summary
Since the advent of highly active antiretroviral therapy (HAART) in 1990s, the management of HIV has resulted in improved quality of life, survival and life expectancy of infected individuals (Antiretroviral Therapy Cohort Collaboration, 2008; van Sighem et al, 2010; Mills et al, 2011; Nakagawa et al, 2012). Definitions of old age vary, a study to evaluate the effects of age on HIV prognosis identified age 50 as a determining factor affecting the course of clinical progression of infection to AIDS and death (Egger et al 2002; Nogueras et al, 2006). This age benchmark is used by the World Health Organization (WHO) and the US Centre for Disease Control and prevention (CDC). Reduced HIV/AIDS mortality due to the efficacy of ART has been identified as one of the various factors responsible for the growing proportion of ageing HIVinfected individuals (Antiretroviral Cohort Collaboration, 2008). More than half of all HIVinfected individuals will be ≥50 years of age by 2015 (Effros et al, 2008; Negin and Cumming, 2010)
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