Polypharmacy and frailty among persons with HIV

Area of Science:

• Gerontology
• Infectious Diseases
• Pharmacology

Background:

• Polypharmacy is a known risk factor for frailty in the general population.
• Limited data exists on polypharmacy's impact on frailty among people living with HIV (PLWH) on antiretroviral (ARV) therapy.

Purpose of the Study:

• To determine the association between polypharmacy and an adapted frailty-related phenotype (aFRP) in PLWH on ARV therapy.
• To compare this association in PLWH with uninfected individuals.

Main Methods:

• Cross-sectional study in 2009 using data from the Veterans Aging Cohort Study.
• Included 1762 PLWH on ARV with suppressed viral load and 2679 uninfected participants.
• Primary predictor: number of chronic non-ARV outpatient medications (pharmacy fill/refill data). Outcome: self-reported aFRP domains (shrinking, exhaustion, slowness, low physical activity).

Main Results:

• Frailty was uncommon (2% PLWH, 3% uninfected), but any aFRP domain was more prevalent (31% PLWH, 41% uninfected).
• Median non-ARV medications were higher in those with any aFRP domain (6 for PLWH, 16 for uninfected).
• Each additional non-ARV medication increased odds of any aFRP domain by 11% in PLWH (OR 1.11) and 4% in uninfected individuals (OR 1.04).

Conclusions:

• A stronger association exists between polypharmacy and frailty indicators in PLWH compared to uninfected individuals.
• Findings suggest the need for further investigation into polypharmacy and frailty in PLWH.
• Potential for medication deprescribing interventions in PLWH to mitigate frailty risk.