Potentially Inappropriate Medications in Older Adults Living With HIV

B López-Centeno; C Badenes-Olmedo; A Mataix-Sanjuan; JM Bellón; L Pérez-Latorre; JC López; J Benedí; S Khoo; C Marzolini; MJ Calvo-Alcántara; J Berenguer

Disclosures

HIV Medicine. 2020;21(8):541-546. 

In This Article

Abstract and Introduction

Abstract

Objectives: We assessed the prevalence of potentially inappropriate medication (PIM) among older (≥ 65 years) people living with HIV (O-PLWH) in the region of Madrid.

Methods: We analysed the dispensation registry of community and hospital pharmacies from the Madrid Regional Health Service (SERMAS) for the period between 1 January and 30 June 2017, looking specifically at PIMs according to the 2019 Beers criteria. Co-medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system.

Results: A total of 6 636 451 individuals received medications. Of these individuals, 22 945 received antiretrovirals (ARVs), and of these 1292 were O-PLWH. Overall, 1135 (87.8%) O-PLWH were taking at least one co-medication, and polypharmacy (at least five co-medications) was observed in 852 individuals (65.9%). A PIM was identified in 482 (37.3%) O-PLWH. Factors independently associated with PIM were polypharmacy [adjusted odds ratio (aOR) 7.08; 95% confidence interval (CI) 5.16–9.72] and female sex (aOR 1.75; 95% CI 1.30–2.35). The distribution of PIMs according to ATC drug class were nervous system drugs (n = 369; 28.6%), musculoskeletal system drugs (n = 140; 10.8%), gastrointestinal and metabolism drugs (n = 72; 5.6%), cardiovascular drugs (n = 61; 4.7%), respiratory system drugs (n = 13; 1.0%), antineoplastic and immunomodulating drugs (n = 10; 0.8%), and systemic anti-infectives (n = 2; 0.2%). Five drugs accounted for 84.8% of the 482O PLWH with PIMs: lorazepam (38.2%), ibuprofen (18.0%), diazepam (10.2%), metoclopramide (9.9%), and zolpidem (8.5%).

Conclusions: Prescription of PIMs is highly prevalent in O-PLWH. Consistent with data in uninfected elderly people, the most frequently observed PIMs were benzodiazepines and nonsteroidal anti-inflammatory drugs. Targeted interventions are warranted to reduce inappropriate prescribing and polypharmacy in this vulnerable population.

Introduction

Potentially inappropriate medication (PIM) is a term used to describe the use of a medicine for which the associated risks outweigh the potential benefits, especially when more effective alternatives are available.[1] Elderly people living with HIV (PLWH) are more likely to be exposed to PIMs because they often have multiple chronic diseases and therefore use a high number of drugs. In a previous analysis, we showed that polypharmacy (defined as taking at least five non-HIV co-medications) was observed overall in 33% of PLWH (median age 48 years) vs. 62% and 80% in PLWH aged 65–75 and ≥ 75 years, respectively.[2] In addition, elderly PLWH experience age-related physiological changes, which can impact drug pharmacokinetics and pharmacodynamics and thereby predispose elderly PLWH to adverse drug reactions.[3]

Common tools to detect inappropriate prescribing in elderly individuals include the Beers criteria[4] and the Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria.[5] These tools list instances of inappropriate drug dosing, indication, treatment duration and treatment omission as well as inappropriate drugs for use in elderly patients.

The advances in antiretroviral therapy (ART) have increased the life expectancy of PLWH and are leading to a growing HIV-infected cohort that is exposed to the risks of age-related comorbidities, age-related physiological changes, and care by multiple providers.[6,7] All these factors could increase the risk of PIM in this population group; however, little is known about the subject. Consequently, we designed this study to assess the prevalence of PIMs among older PLWH.

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