Prevalence of polypharmacy and pharmacotherapy complexity in elderly people living with HIV in Spain. POINT study

Abstract

ObjectiveTo determine the prevalence of polypharmacy in persons living with HIV of at least 65 years of age receiving antiretroviral treatment. A characterization of antiretroviral treatment, as well as a determination of the prevalence of comorbidities; of the most common types of concomitant medication; of adherence rates; of the pharmacotherapeutic complexity; and of drug-drug interactions were also among the goals of the study. MethodTh is was a multi-center, cross-sectional observational study that included persons living with HIV aged 65 years or more who were on active antiretroviral treatment. Demographic, clinical (viral load, CD4 count and comorbidities) and pharmacotherapeutic (type of antiretroviral treatment: single tablet regimen, polypharmacy [six active ingredients or more] and major polypharmacy [11 active ingredients or more] variables were considered). Adherence to antiretroviral treatment was measured by dispensation records and the Simplified Medication Adherence Questionnaire, while adherence to concomitant medication was measured using dispensation records and the Morisky-Green questionnaire. The Medication Regimen Complexity Index was calculated. Drug-drug interactions were analyzed using the Liverpool and Lexicomp databases. ResultsSeventy-four patients (86.5% male) were included, with a median age of 69 years (66.7-72.0). The sexual route was the most common route of transmission of the disease (67.6%). The virus was undetectable in 89.2% of patients; the CD4 count was over 200/mL in 94.6% of the sample. The median number of comorbidities was 3.5 (2.0-5.0), 52.7% of them being cardiovascular; 50.0% related to the central nervous system; 176% hepatic; and 8.1% consisting in chronic pulmonary disease. A total of 81.1% of patients received triple therapy and 48.6% single tablet regimen. The median number of concomitant drugs administered was 5.0 (2.0-70), polypharmacy was observed in 71.6% of cases and major polypharmacy in 25.7%. Antihypertensive and cardiovascular drugs were prescribed to 56.8% of patients, lipid-lowering drugs to 50.0%, antiulcer agents to 33.8% and psychoactive drugs to 32.4%. According to dispensation records, adherence to antiretroviral treatment was 85.1% and to concomitant medication 62.8%. The median Medication Regimen Complexity Index for the whole treatment was 13.0 (8.0-176). Potential drug-drug interactions were observed in 55.4% of patients and contraindicated interactions in 12.2%. ConclusionsElderly persons living with HIV exhibit a high prevalence of polypharmacy, pharmacotherapeutic complexity, poor adherence and drug-drug interactions. For that reason, pharmacotherapeutic optimization must be a priority in these patients.