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J Am Geriatr Soc. 2014 Mar;62(3):447-53. doi: 10.1111/jgs.12695. Epub 2014 Feb 27.

Polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults with human immunodeficiency virus infection.

Author information

1
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California; San Francisco Veterans Affairs Medical Center, San Francisco, California.

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.

KEYWORDS:

HIV infection; drug interactions; inappropriate prescribing; polypharmacy

PMID:
24576251
PMCID:
PMC4043391
DOI:
10.1111/jgs.12695
[Indexed for MEDLINE]
Free PMC Article
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