PMID- 29135584
DCOM- 20180709
LR  - 20180709
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 32
IP  - 1
DP  - 2018 Jan 2
TI  - Concomitant medication polypharmacy, interactions and imperfect adherence are
      common in Australian adults on suppressive antiretroviral therapy.
PG  - 35-48
LID - 10.1097/QAD.0000000000001685 [doi]
AB  - OBJECTIVES: We quantified concomitant medication polypharmacy, pharmacokinetic
      and pharmacodynamic interactions, adverse effects and adherence in Australian
      adults on effective antiretroviral therapy. DESIGN: Cross-sectional. METHODS:
      Patients recruited into a nationwide cohort and assessed for prevalence and type 
      of concomitant medication (including polypharmacy, defined as >/=5 concomitant
      medications), pharmacokinetic or pharmacodynamic interactions, potential
      concomitant medication adverse effects and concomitant medication adherence.
      Factors associated with concomitant medication polypharmacy and with imperfect
      adherence were identified using multivariable logistic regression. RESULTS: Of
      522 participants, 392 (75%) took a concomitant medication (mostly cardiovascular,
      nonprescription or antidepressant). Overall, 280 participants (54%) had
      polypharmacy of concomitant medications and/or a drug interaction or
      contraindication. Polypharmacy was present in 122 (23%) and independently
      associated with clinical trial participation, renal impairment, major
      comorbidity, hospital/general practice-based HIV care (versus sexual health
      clinic) and benzodiazepine use. Seventeen participants (3%) took at least one
      concomitant medication contraindicated with their antiretroviral therapy, and 237
      (45%) had at least one pharmacokinetic/pharmacodynamic interaction. Concomitant
      medication use was significantly associated with sleep disturbance and myalgia,
      and polypharmacy of concomitant medications with diarrhoea, fatigue, myalgia and 
      peripheral neuropathy. Sixty participants (12%) reported imperfect concomitant
      medication adherence, independently associated with requiring financial support, 
      foregoing necessities for financial reasons, good/very good self-reported general
      health and at least 1 bed day for illness in the previous 12 months. CONCLUSION: 
      In a resource-rich setting with universal healthcare access, the majority of this
      sample took a concomitant medication. Over half had at least one of concomitant
      medication polypharmacy, pharmacokinetic or pharmacodynamic interaction.
      Concomitant medication use was associated with several adverse clinical outcomes.
FAU - Siefried, Krista J
AU  - Siefried KJ
AD  - aSt Vincent's Centre for Applied Medical Research, St Vincent's Hospital,
      SydneybCentre for Social Research in HealthcNeuroscience Research Australia,
      University of New South Wales, SydneydNational Association of People with HIV
      Australia, NewtowneSchool of Public Health and Community Medicine, University of 
      New South Wales, Sydney, New South WalesfDepartment of Infectious Diseases,
      Alfred Hospital and Monash UniversitygDepartment of Infectious Diseases, The
      Royal Women's HospitalhMonash Infectious Diseases, Monash Health, Melbourne,
      VictoriaiAlbion Centre, South Eastern Sydney Local Hospital Network, Sydney, New 
      South WalesjCentre for Population Health, Burnet InstitutekMelbourne Sexual
      Health Centre, Alfred HealthlCentral Clinical School, Faculty of Medicine,
      Nursing and Health Sciences, Monash University, Melbourne, VictoriamWestern
      Sydney Sexual Health Centre, University of Sydney, ParramattanWestmead Clinical
      School, Sydney Medical School, University of Sydney, Westmead, New South
      WalesoCentre Clinic, St Kilda, Melbourne, VictoriapHoldsworth House Medical
      PracticeqThe Kirby Institute, University of New South Wales, Sydney, New South
      Wales, AustraliarDepartment of Interdisciplinary Social Science, Utrecht
      University, Utrecht, The Netherlands.
FAU - Mao, Limin
AU  - Mao L
FAU - Cysique, Lucette A
AU  - Cysique LA
FAU - Rule, John
AU  - Rule J
FAU - Giles, Michelle L
AU  - Giles ML
FAU - Smith, Don E
AU  - Smith DE
FAU - McMahon, James
AU  - McMahon J
FAU - Read, Tim R
AU  - Read TR
FAU - Ooi, Catriona
AU  - Ooi C
FAU - Tee, Ban K
AU  - Tee BK
FAU - Bloch, Mark
AU  - Bloch M
FAU - de Wit, John
AU  - de Wit J
FAU - Carr, Andrew
AU  - Carr A
CN  - PAART study investigators
LA  - eng
PT  - Journal Article
PL  - England
JT  - AIDS (London, England)
JID - 8710219
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
SB  - X
MH  - Adult
MH  - Aged
MH  - Anti-Retroviral Agents/adverse effects/pharmacokinetics/*therapeutic use
MH  - Australia
MH  - Cross-Sectional Studies
MH  - *Drug Interactions
MH  - Female
MH  - HIV Infections/*drug therapy
MH  - Humans
MH  - Male
MH  - *Medication Adherence
MH  - Middle Aged
MH  - *Polypharmacy
PMC - PMC5732638
EDAT- 2017/11/15 06:00
MHDA- 2018/07/10 06:00
CRDT- 2017/11/15 06:00
PHST- 2017/11/15 06:00 [pubmed]
PHST- 2018/07/10 06:00 [medline]
PHST- 2017/11/15 06:00 [entrez]
AID - 10.1097/QAD.0000000000001685 [doi]
PST - ppublish
SO  - AIDS. 2018 Jan 2;32(1):35-48. doi: 10.1097/QAD.0000000000001685.