Riassunto analitico
Background
After the widespread introduction of the Highly Active Antiretroviral Therapy (HAART) long term survival above HIV+ patients increased significantly. Currently, almost 50% of HIV-infected people in high-income countries is aged 50 or older and it is estimated that the percentage of >65 years old HIV-infected patients will raise to 48% by 2030.
Older adults Living with HIV (OALWH) experience greater prevalence of chronic non-infectious co-morbidities (NICMs) and multi-morbidity (MM), which brings heightened risk of polypharmacy (PP), potentially inappropriate medication (PIM) use and drug-drug interactions. This can lead to greater health costs, morbidity, hospital admissions and mortality
Frailty is gaining more and more importance among the evaluation of patients ageing with HIV because of its association with NICM and mortality. The purpose of frailty measurement is to monitor clinical intervention, quantify the effects of disease progression and identify those individuals who are more vulnerable to adverse events. A 37-item frailty index (FI) was previously proposed to measure frailty in people living with HIV (PLWH).
Aim of this study is to evaluate changes in prescriptions of drugs other than ARV in an ageing population. Secondary objective is to assess the association of polypharmacy and frailty using a 37-item Frailty Index.
Methods
This is a retrospective longitudinal study including consecutive patients attended the Modena HIV Metabolic Clinic.
We included patients with an age older the 65 years at the last visit and we retrospectively collected drug prescriptions. Other inclusion criteria were: HIV viral load below limit of detection for at least 12 months and attending at least 2 clinical evaluations.
“Frailty” was defined as 37-item FI >0.31.
Polypharmacy was defined as more than 5 drugs other than ARV.
Multivariable logistic regression for panel data was used to evaluate factors associated with polypharmacy.
Results
A total of 181 patients were included, 101 (55.8%) of them experienced PP. 145 (80%) patients were men, 85 of them with PP: no gender difference were found between groups (p=0.137). Median age of the cohort at last visit was 69 (IQR 66-72) years. Patients with PP were slightly older than others (median “no PP” 67.5 vs. PP 69, p=0.027).
At last visit, median FI was 0.33 (IQR 0.27-0.40). Median FI were 0.31 (IQR 0.26-0.38) in “no PP” and 0.36 (IQR 0.27-0.41) in PP, no differences were noted (p=0.227).
A total of 1078 evaluations were retrospectively collected and used to build a multivariable logistic model for panel data adjusted for age and sex.
PP was associated with FI (OR=2.92, p=0.005), age (OR=1.19, p=0.000), sex (OR=2.21, p=0.015) and INSTIs (OR=1.43, p=0.007).
Conclusions
Polypharmacy is a main problem in HIV ageing population, considering that more than half of PLWH over 65 years of age experience Polypharmacy.
The major result of our study was that polypharmacy was associated with frailty.
Since polypharmacy represents a major risk for disability and frailty, structured intervention should be built by clinicians in order to avoid the risks of iatrogenic triad of polypharmacy, with particular regards to frail patients.
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