Riassunto analitico
Abstract Background The management of multi-morbidities in HIV patients is associated with polypharmacy (PP) and attendant risks of toxicity and drug interactions. We sought to examine the relationship between multi-morbidities, frailty polypharmacy and clinical harms (mortality, falls). Methods A 10 years analysis of Modena HIV Metabolic Clinic Cohort to December 2015. PP was defined as the chronic use of 5 or more medications excluding antiretroviral drugs. Frailty was calculated on the established deficit accumulation approach with Frailty Index (FI) and was defined as its value above the 3rd quartile of the study sample. Given the co-linearity between PP and multi-morbidity (MM), FI was chosen to discriminate the health profile and the state of vulnerability to adverse outcome of the patients included in the cohort with and without PP. Findings 3,581 patients were included (66% males) accounting for 11,565 person-years follow-up. The prevalence of polypharmacy significantly increased over calendar year from 2•89% in 2006 to 15•23% in 2015 (p <0•001) with a mortality rate of 4•67/1000 person-year. Multivariable analysis showed polypharmacy, frailty and current CD4<100 or 101-350 to be significantly associated with poor survival. Forty-nine (13•6%) patients reported >1 fall (falls rate was 2•30/100 person-year). In multivariate analysis, , a trend for risk of fall was shown for PP, while frailty, was significantly associated with it. Interpretation In frail HIV-infected patients, PP was associated with poor survival and falls. To mitigate this risk a regular medication reviews by health providers should be undertaken.
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Abstract
Abstract
Background
The management of multi-morbidities in HIV patients is associated with polypharmacy (PP) and attendant risks of toxicity and drug interactions. We sought to examine the relationship between multi-morbidities, frailty polypharmacy and clinical harms (mortality, falls).
Methods
A 10 years analysis of Modena HIV Metabolic Clinic Cohort to December 2015. PP was defined as the chronic use of 5 or more medications excluding antiretroviral drugs. Frailty was calculated on the established deficit accumulation approach with Frailty Index (FI) and was defined as its value above the 3rd quartile of the study sample. Given the co-linearity between PP and multi-morbidity (MM), FI was chosen to discriminate the health profile and the state of vulnerability to adverse outcome of the patients included in the cohort with and without PP.
Findings
3,581 patients were included (66% males) accounting for 11,565 person-years follow-up. The prevalence of polypharmacy significantly increased over calendar year from 2•89% in 2006 to 15•23% in 2015 (p <0•001) with a mortality rate of 4•67/1000 person-year. Multivariable analysis showed polypharmacy, frailty and current CD4<100 or 101-350 to be significantly associated with poor survival. Forty-nine (13•6%) patients reported >1 fall (falls rate was 2•30/100 person-year). In multivariate analysis, , a trend for risk of fall was shown for PP, while frailty, was significantly associated with it.
Interpretation
In frail HIV-infected patients, PP was associated with poor survival and falls. To mitigate this risk a regular medication reviews by health providers should be undertaken.
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