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Polypharmacy, Drug–Drug Interactions, and Potentially Inappropriate Medications in Older Adults with Human Immunodeficiency Virus Infection
Author(s) -
Greene Meredith,
Steinman Michael A.,
McNicholl Ian R.,
Valcour Victor
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12695
Subject(s) - medicine , polypharmacy , drug , depression (economics) , anticholinergic , human immunodeficiency virus (hiv) , beers criteria , psychiatry , immunology , economics , macroeconomics
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 ( PIM s) according to the modified B eers Criteria, anticholinergic drug burden according to the A nticholinergic R isk S cale ( ARS ), and drug–drug interactions using the L exi‐ I nteract online drug interactions database. Results Of 89 HIV‐positive participants, most were C aucasian (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 C ategory 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.