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Polypharmacy in HIV: recent insights and future directions
E Jennifer Edelman1, Christopher T Rentsch2,3, Amy C Justice1,2
1Yale Schools of Medicine and Public Health, New Haven.
Current Opinion in HIV and AIDS
|December 14, 2019
Summary
Polypharmacy, the use of multiple medications, is common in people with HIV (PWH) and linked to adverse events like falls and hospitalization. Further research is needed to understand drug interactions and improve management.
Area of Science:
- Gerontology
- Pharmacology
- Infectious Diseases
Background:
- Polypharmacy is prevalent among people with HIV (PWH), particularly in middle age.
- Nonantiretroviral (ARV) medications are the primary drivers of polypharmacy in PWH.
- Existing research highlights associations between polypharmacy and potentially inappropriate medications (PIMs).
Purpose of the Study:
- To update findings on polypharmacy in people with HIV (PWH).
- To identify critical research needs for managing polypharmacy in PWH.
Main Methods:
- Review of current literature on polypharmacy in PWH.
- Analysis of associations between polypharmacy and adverse events, adjusting for illness severity.
- Consideration of various mechanisms contributing to polypharmacy-related harm.
Main Results:
- Polypharmacy is common in PWH and associated with increased risks of falls, delirium, pneumonia, hospitalization, and mortality.
- These risks persist even after adjusting for the severity of illness.
- Mechanisms of harm include PIMs, drug interactions, and drug-substance use interactions.
Conclusions:
- Polypharmacy is a growing concern for PWH, contributing to significant adverse health outcomes.
- Understanding modifiable mechanisms of injury requires further observational research.
- Future research should utilize large datasets, biomarkers, and advanced statistical methods to inform clinical interventions for polypharmacy in PWH.
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