Relationship of Polypharmacy to HIV RNA Suppression in People Aged ≥ 50 Years Living With HIV

MM Murray; J Lin; A Buros Stein; ML Wilcox; J Cottreau; M Postelnick; FJ Palella

Disclosures

HIV Medicine. 2021;22(8):742-749. 

In This Article

Results

A total of 621 patients met the criteria for inclusion in the study. The majority of patients were Caucasian (n = 341; 54.9%) and male (n = 521; 83.9%). Patients taking > 15 medications were less likely to have an undetectable plasma HIV RNA (OR 0.51; 95% CI 0.29–0.93; P = 0.02). Therefore, patients were grouped dichotomously by whether they received ≤ 15 medications or > 15 medications for the remainder of the analyses.

The median age was 57 years [interquartile range (IQR) 54–62 years], with a median of 6 clinic visits (IQR 4–8) for patients taking ≤ 15 medications. For patients taking > 15 medications, the median age was 59 years (IQR 55–65.5 years), with a median of 6 clinic visits (IQR 4–9.5; Table 1). Patients taking ≤ 15 medications had a higher median CD4 T-lymphocyte count compared with patients taking > 15 medications [495 (IQR 332–664) vs. 392 (IQR 215–525) cells/μL, respectively; P < 0.01]. There was no difference in the number of patients with CD4 count < 200 vs. > 200 by number of medications received (P = 0.08). INSTI-based ART regimens were the most common among patients taking ≤ 15 medications (n = 185; 32.9%), and other-type ART regimens were the most common among patients receiving > 15 medications (n = 20; 33.9%). Approximately 71% of patients taking ≤ 15 medications took once-daily ART, while 52.5% of patients taking > 15 medications were taking once-daily ART (P = 0.01). In comparison, approximately 28.1% of patients with ≤ 15 medications received twice-daily ART regimens; 42.4% of patients with > 15 medications were taking twice-daily ART medications (P = 0.03). The difference in self-reported adherence between the two groups was not statistically significant (P = 0.81).

When comorbidities were analysed, there was a statistically significantly higher percentage of patients taking > 15 vs. < 15 medications who had any of the following diagnoses: diabetes, hyperlipidaemia, CVD, pulmonary disease, chronic kidney disease, renal dialysis, gastroesophageal reflux disease, depression/anxiety and osteoporosis (P < 0.05 for all; Table 1). There were 21 (40.4%) patients taking > 15 medications with a fasting blood glucose level at goal (< 100 mg/dL) and 389 (72%) patients taking ≤ 15 medications with a fasting blood glucose level at goal (P < 0.01; Table 2). The median number of clinic visits for patients with depression/anxiety was 6 visits (IQR 1–39) and for patients without depression/anxiety it was 5 (IQR 1–57; P < 0.01).

Of patients taking ≤ 15 medications, 464 (82.6%) had at least one DDI, compared with 58 (98.3%) of the patients taking > 15 medications (P < 0.01; Table 2). The median number of DDIs was 3 (IQR 2–6) for patients taking ≤ 15 medications and 10 (IQR 7–15) for patients taking > 15 medications (P < 0.01). There was no significant association between likelihood of viral suppression and number of DDIs (P = 0.98). Among patients taking ≤ 15 medications, AEs occurred in 159 patients (28.3%) compared to 20 patients (33.9%) taking > 15 medications (P = 0.45). There were no differences in AEs, DDIs or achievement of target values based on gender (P > 0.05 for all).

There was a higher percentage of patients taking ≤ 15 medications who had an undetectable plasma HIV RNA (n = 453; 80.6%) compared with patients taking > 15 medications (n = 40; 67.8%; P = 0.03). In the univariate logistic regression model, older age, hyperlipidaemia, receiving an INSTI-based ART regimen, depression/anxiety and receiving statin medications were all factors that were associated with an increased likelihood of an undetectable plasma HIV RNA level (Table 3). African American race, pulmonary disease and receiving > 15 medications were risk factors for a decreased likelihood of having an undetectable plasma HIV RNA. In the multivariate model, depression/anxiety (OR 1.96; 95% CI 1.2–3.3), hyperlipidaemia (OR 1.96; 95% CI 1.25–3.13) and self-reported adherence (OR 2.01; 95% CI 1.32–3.06) increased the odds of having an undetectable plasma HIV RNA vs. having a detectable plasma HIV RNA. Taking > 15 medications (OR 0.49; 95% CI 0.26–0.96), pulmonary disease (OR 0.54; 95% CI 0.3–0.97) and CD4 T-lymphocyte count < 200 cells/μL (OR 0.39; 95% CI 0.22–0.68) were associated with decreased likelihood of having an undetectable plasma HIV RNA (Figure 1).

Figure 1.

Odds ratio (OR) plot for the multivariate logistic regression model with undetectable plasma HIV RNA as the outcome. CI, confidence interval; HLD, hyperlipidaemia; Meds, medications.

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