Polypharmacy in HIV: Rethinking what counts and why it matters.

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Pharmacology

Background:

• Polypharmacy (concurrent use of multiple medications) is a growing challenge in HIV care due to aging populations and increased comorbidities.
• Current definitions of polypharmacy, often from geriatric medicine (≥5 medications), may not adequately capture the complexity of HIV treatment, including lifelong antiretroviral therapy (ART).
• Inconsistent definitions hinder accurate assessment and management of polypharmacy in HIV research.

Purpose of the Study:

• To review and compare definitions and assessments of polypharmacy in HIV studies versus geriatric research.
• To adapt existing geriatric polypharmacy assessment tools (e.g., STOPP/START, Beers criteria) for the unique context of HIV care.
• To explore the link between polypharmacy in HIV and negative health outcomes, and discuss deprescribing strategies.

Main Methods:

• Literature review comparing polypharmacy definitions in HIV and geriatric studies.
• Analysis of existing polypharmacy assessment tools and their applicability to HIV care.
• Review of evidence linking HIV polypharmacy to adverse events and healthcare costs.

Main Results:

• Polypharmacy definitions vary significantly in HIV research, unlike more standardized geriatric approaches.
• Evidence suggests HIV polypharmacy is associated with increased drug-drug interactions, hospitalizations, and reduced quality of life.
• Appropriateness, safety, and individual health needs are more critical than medication count alone.

Conclusions:

• HIV care requires an adapted polypharmacy framework that considers unique pharmacologic, psychosocial, and adherence factors.
• Shifting focus from medication count to appropriateness and safety can improve prescribing and patient outcomes.
• Deprescribing holds promise but requires careful consideration to maintain ART stability and support shared decision-making in aging HIV care.