• Aging
• ART
• Deprescribing
• HIV
• Polypharmacy

BACKGROUND
The objective of the study was to describe prevalence and risk factors for polypharmacy and two-drug regimens (2DR) antiretroviral therapy (ART) prevalence in the period 2006-2020. The relationship between these two variables was described depicting four phenotypes of people living with HIV (PLWH): individuals not switching to 2DR (so called healthy and unhealthy Residents) and individuals who switch to 2DR (so called healthy and unhealthy Migrants).

MATERIALS AND METHODS
This was an observational longitudinal matched-cohort study that included ART-experienced PLWH attending Modena HIV Metabolic Clinic (MHMC), Italy, from January 2006 to December 2020. Consecutive ART-experienced PLWH, 2DR-naïve at baseline, aged ≥ 18 years with at least three visits at MHMC were included in the initial analysis. PLWH were divided into two groups: Residents (2DR-naïve) and Migrants (2DR-switchers). The groups were matched for similar observation time since entrance in the MHMC cohort (T1-T0). Time zero (T0) represents the date of the first visit at the MHMC in both groups. In Migrants, time 1 (T1) is the visit date of switching to 2DR. In Residents, T1 was chosen as the closest visit to the date of switch in Migrants. Time 2 (T2) represents the date of the last visit in MHMC. Both groups were further categorized as healthy and unhealthy, based on the presence of multimorbidity (defined as ≥ 3 co-morbidities). Polypharmacy was defined as the use of >5 drugs other that ART. Multivariable logistic regression was used to identify predictors of both polypharmacy and 2DR switch.

RESULTS
The prevalence of polypharmacy increased from 2.6% in 2006 to 16.1% in 2020, as well as the use of 2DR regimens, that increased from 1.7% in 2006 to 26.1% in 2020. 385 PLWH (75.6% males), respectively 162 Migrants and 223 Residents, were analyzed. The median age was 51.9 ± 8.4 years, median CD4 was 680 (526.3 – 852.3) and HIV RNA viral load was undetectable in 370 (96.1%) at T1. Migrants were older than Residents (53.2 vs. 51.1 years, p=0.02) and had longer HIV exposure (22.0 vs. 19.0 years, p=0.02). The mean number of drugs to treat co-morbidities was higher in Migrants (3.3 vs. 2.7, p=0.03), but polypharmacy did not show statistically significant differences between the two groups (17% vs 11.7%, p=0.16).
HIV duration, waist circumference, polypharmacy and age were not associated with switch to 2DR. Risk factors for polypharmacy were short physical performance battery (OR=0.72, 0.54-0.97, p=0.032), body mass index (OR=1.17, 1.04-1.32, p=0.008), HIV duration (OR=1.08, 1.02-1.15, p=0.008), age (OR=1.08, 1.02-1.15, p=0.012) and male sex (OR=6.18, 1.42-26.9, p=0.015).

Four phenotypes were analyzed: 118 healthy Residents (without 2DR and multimorbidity), 105 unhealthy Residents (without 2DR and with multimorbidity), 77 healthy Migrants (2DR without multimorbidity) and 85 unhealthy Migrants (2DR with multimorbidity).

As expected, polypharmacy was predicted by unhealthy Migrants (OR=3.3, 1.23-8.85, p=0.017) and unhealthy Residents (OR=4.0, 1.58-10.13, p=0.004) phenotypes while 2DR was not associated with this outcome.

CONCLUSION
In the period 2006-2020 it was observed a parallel increase in 2DR and polypharmacy trends. PLWH with 2DR are heterogenous population in which polypharmacy does not represent a major driver for switch. Future studies may identify 2DR strategies in the management of polypharmacy, into a deprescribing options.

BACKGROUND The objective of the study was to describe prevalence and risk factors for polypharmacy and two-drug regimens (2DR) antiretroviral therapy (ART) prevalence in the period 2006-2020. The relationship between these two variables was described depicting four phenotypes of people living with HIV (PLWH): individuals not switching to 2DR (so called healthy and unhealthy Residents) and individuals who switch to 2DR (so called healthy and unhealthy Migrants). MATERIALS AND METHODS This was an observational longitudinal matched-cohort study that included ART-experienced PLWH attending Modena HIV Metabolic Clinic (MHMC), Italy, from January 2006 to December 2020. Consecutive ART-experienced PLWH, 2DR-naïve at baseline, aged ≥ 18 years with at least three visits at MHMC were included in the initial analysis. PLWH were divided into two groups: Residents (2DR-naïve) and Migrants (2DR-switchers). The groups were matched for similar observation time since entrance in the MHMC cohort (T1-T0). Time zero (T0) represents the date of the first visit at the MHMC in both groups. In Migrants, time 1 (T1) is the visit date of switching to 2DR. In Residents, T1 was chosen as the closest visit to the date of switch in Migrants. Time 2 (T2) represents the date of the last visit in MHMC. Both groups were further categorized as healthy and unhealthy, based on the presence of multimorbidity (defined as ≥ 3 co-morbidities). Polypharmacy was defined as the use of >5 drugs other that ART. Multivariable logistic regression was used to identify predictors of both polypharmacy and 2DR switch. RESULTS The prevalence of polypharmacy increased from 2.6% in 2006 to 16.1% in 2020, as well as the use of 2DR regimens, that increased from 1.7% in 2006 to 26.1% in 2020. 385 PLWH (75.6% males), respectively 162 Migrants and 223 Residents, were analyzed. The median age was 51.9 ± 8.4 years, median CD4 was 680 (526.3 – 852.3) and HIV RNA viral load was undetectable in 370 (96.1%) at T1. Migrants were older than Residents (53.2 vs. 51.1 years, p=0.02) and had longer HIV exposure (22.0 vs. 19.0 years, p=0.02). The mean number of drugs to treat co-morbidities was higher in Migrants (3.3 vs. 2.7, p=0.03), but polypharmacy did not show statistically significant differences between the two groups (17% vs 11.7%, p=0.16). HIV duration, waist circumference, polypharmacy and age were not associated with switch to 2DR. Risk factors for polypharmacy were short physical performance battery (OR=0.72, 0.54-0.97, p=0.032), body mass index (OR=1.17, 1.04-1.32, p=0.008), HIV duration (OR=1.08, 1.02-1.15, p=0.008), age (OR=1.08, 1.02-1.15, p=0.012) and male sex (OR=6.18, 1.42-26.9, p=0.015). Four phenotypes were analyzed: 118 healthy Residents (without 2DR and multimorbidity), 105 unhealthy Residents (without 2DR and with multimorbidity), 77 healthy Migrants (2DR without multimorbidity) and 85 unhealthy Migrants (2DR with multimorbidity). As expected, polypharmacy was predicted by unhealthy Migrants (OR=3.3, 1.23-8.85, p=0.017) and unhealthy Residents (OR=4.0, 1.58-10.13, p=0.004) phenotypes while 2DR was not associated with this outcome. CONCLUSION In the period 2006-2020 it was observed a parallel increase in 2DR and polypharmacy trends. PLWH with 2DR are heterogenous population in which polypharmacy does not represent a major driver for switch. Future studies may identify 2DR strategies in the management of polypharmacy, into a deprescribing options.