Prevalence of polypharmacy and pharmacotherapy complexity in elderly people living with HIV in Spain. POINT study

To determine the prevalence of polypharmacy in persons living with  HIV of at least 65 years of age receiving antiretroviral treatment. A  characterization of antiretroviral treatment, as well as a determination of the  prevalence of comorbidities; of the most common types of concomitant medication; of adherence rates; of the pharmacotherapeutic  complexity; and of drug-drug interactions were also among the goals of the  study.

This was a multi-center, cross-sectional observational study that  included persons living with HIV aged 65 years or more who were on active  antiretroviral treatment. Demographic, clinical (viral load, CD4 count and  comorbidities) and pharmacotherapeutic (type of antiretroviral treatment: single tablet regimen, polypharmacy [six active ingredients or more] and major  polypharmacy [11 active ingredients or more] variables were considered).  Adherence to antiretroviral treatment was measured by dispensation records and the Simplified Medication Adherence Questionnaire, while adherence to  concomitant medication was measured using dispensation records and the  Morisky-Green questionnaire. The Medication Regimen Complexity Index was  calculated. Drug-drug interactions were analyzed using the Liverpool and  Lexicomp databases.

Seventy-four patients (86.5% male) were included, with a median age  of 69 years (66.7-72.0). The sexual route was the most common route of  transmission of the disease (67.6%). The virus was undetectable in 89.2% of  patients; the CD4 count was over 200/mL in 94.6% of the sample. The median  number of comorbidities was 3.5 (2.0-5.0), 52.7% of them being cardiovascular; 50.0% related to the central nervous system; 17.6% hepatic; and 8.1%  consisting in chronic pulmonary disease. A total of 81.1% of patients received  triple therapy and 48.6% single tablet regimen. The median number of  concomitant drugs administered was 5.0 (2.0-7.0), polypharmacy was observed  in 71.6% of cases and major polypharmacy in 25.7%. Antihypertensive and  cardiovascular drugs were prescribed to 56.8% of patients, lipid-lowering drugs  to 50.0%, antiulcer agents to 33.8% and psychoactive drugs to 32.4%.  According to dispensation records, adherence to antiretroviral treatment was  85.1% and to concomitant medication 62.8%. The median Medication Regimen Complexity Index for the whole treatment was 13.0 (8.0-17.6). Potential drug- drug interactions were observed in 55.4% of patients and contraindicated interactions in 12.2%.

Elderly persons living with HIV exhibit a high prevalence of  polypharmacy, pharmacotherapeutic complexity, poor adherence and drug-drug  interactions. For that reason, pharmacotherapeutic optimization must be a  priority in these patients.