Older HIV-infected adults. Complex patients (III): Polypharmacy

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Pharmacology

Background:

• Polypharmacy is a known issue in the elderly.
• People living with HIV (PLWH) now have increased life expectancy, leading to polypharmacy challenges.
• Traditional polypharmacy definitions are problematic for PLWH due to antiretroviral (ARV) use.

Purpose of the Study:

• To define and address polypharmacy in people living with HIV (PLWH).
• To explore the consequences and interventions for polypharmacy in PLWH.
• To consider future directions in antiretroviral therapy (ART) to reduce polypharmacy.

Main Methods:

• Reviewing the definition and prevalence of polypharmacy in PLWH.
• Analyzing consequences such as adverse effects, drug interactions, and adherence issues.
• Evaluating interventions including fixed-dose combination (FDC) tablets and medication deprescribing.

Main Results:

• Polypharmacy prevalence is higher in PLWH than the general population, even excluding ARVs.
• Consequences include geriatric syndromes, drug-drug interactions, and adherence problems.
• Interventions aim to reduce pill burden and improve medication management.

Conclusions:

• A nuanced approach to polypharmacy, focusing on 'appropriate' or 'safer' use, is beneficial for PLWH.
• Fixed-dose combination tablets and deprescribing are key strategies.
• Future ART regimens, like two-drug options, hold promise for reducing polypharmacy risks in PLWH.