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

Results

During the study period, 6 636 451 different individuals received medications in the region of Madrid; of these individuals, 22 945 received ARVs, and of these, 1292 (5.6%) were older PLWH. The median (IQR) age was 69 (67–73) years, and 1027 (79.5%) were male. Overall, 1135 (87.8%) older PLWH were taking at least one co-medication, and polypharmacy was observed in 852 individuals (65.9%).

A full description of ARV use in older PLWH is shown in Table S1. The distribution of anchor ARVs per patient was as follows: integrase strand transfer inhibitors (INSTIs), 645 (49.9%); nonnucleoside reverse transcriptase inhibitors (NNRTIs), 566 (43.8%); and ritonavir- or cobicistat-boosted protease inhibitors (PIs), 328 (25.4%). The most frequently prescribed anchor ARVs were dolutegravir (29.6%), boosted darunavir (18.8%), and rilpivirine (15.9%). Overall, 1023 (79.2%) older PLWH were treated with at least one NRTI. The most frequently used NRTI combinations were abacavir/lamivudine (44.7%), tenofovir disoproxilfumarate/emtricitabine (23.6%), and tenofovir alafenamide/emtricitabine (8.0%).

A full description of the co-medications prescribed to older PLWH classified by ATC therapeutic subgroup is shown in Table S2. The most frequently prescribed co-medications were cardiovascular drugs (C), 900 patients (69.7%); gastrointestinal and metabolism drugs (A), 881 patients (68.2%); nervous system drugs (N), 788 (61.0%); blood drugs (B) 504 (39.0%); and systemic anti-infectives (J), 435 (33.7%).

At least one PIM was identified in 482 (37.3%) older PLWH; in these patients, the most frequent ATC classes involved in PIMs were nervous system drugs N (28.6%), musculoskeletal system drugs (M; 10.8%), A (5.6%), and C (4.7%) (see Figure 1 for a full description). Thirty-one different co-medications caused 667 PIMs among 482 older PLWH; of these PIMs, 293 (60.8%) involved benzodiazepines, and 131 (27.2%) involved nonsteroidal anti-inflammatory drugs (NSAIDs; see Table 1 for a detailed description). Five co-medications accounted for 84.8% of PIMs: lorazepam (38.2%), ibuprofen (18.0%), diazepam (10.2%), metoclopramide (9.9%), and zolpidem (8.5%).

Figure 1.

Potentially inappropriate medications (PIMs) prescribed to 1292 older people living with HIV (PLWH)according to Anatomical Therapeutic Chemical (ATC) drug class. GI, gastrointestinal.

A total of 72 (14.9%) PIMs involved anticholinergic drugs, the most frequent of which were amitriptyline (1.3%), butylscopolamine (1.3%), dexchlorpheniramine (1.0%), hydroxyzine (0.7%), and cyclobenzaprine (0.5%).

Factors independently associated with PIM were polypharmacy [adjusted odds ratio (aOR) 7.08; 95% CI 5.16–9.72] and female sex (aOR 1.75; 95% CI 1.30–2.35).

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