Sedative co-medication patterns across frailty states in people with HIV: a network-based study

Area of Science:

• Gerontology
• Pharmacology
• Infectious Diseases (HIV/AIDS)

Background:

• People with HIV are living longer, increasing the risk of frailty and adverse drug interactions.
• Sedative medications pose a particular risk for drug interactions in frail individuals with HIV.

Purpose of the Study:

• To analyze sedative co-medication patterns across different frailty states (robust, prefrail, frail) in people with HIV.
• To identify specific medications driving complex drug interactions.
• To understand how frailty influences sedative polypharmacy and interaction risks.

Main Methods:

• Cross-sectional analysis of 321 participants using sedatives from the Positive Brain Health Now Cohort.
• Categorization of participants into robust, prefrail, and frail groups based on the modified Fried Frailty Phenotype.
• Network-based analysis of sedative co-medication using the Sedative Load Model, Neighborhood Shift Scores (NESH), and ΔBetweenness.

Main Results:

• Frail individuals exhibited the most complex sedative networks (graph density: 0.24), followed by prefrail (0.18) and robust (0.13) groups.
• Key medications influencing network complexity included mirtazapine, gabapentin, and pregabalin.
• High-risk sedative pairs were more prevalent in frail individuals (e.g., hydromorphone-clonazepam), with intermediate risks in prefrail individuals.

Conclusions:

• Sedative co-medication patterns and interaction risks significantly increase with advancing frailty in people with HIV.
• The prefrail stage represents a critical window for interventions to reduce polypharmacy and enhance medication safety.
• Identifying key medications and network patterns can guide safer prescribing practices for this population.