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Polypharmacy, Drug–Drug Interactions, and Potentially Inappropriate Medications in Older Adults with Human Immunodeficiency Virus Infection

Authors

  • Meredith Greene MD,

    Corresponding author
    1. Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
    2. San Francisco Veterans Affairs Medical Center, San Francisco, California
    • Address correspondence to Meredith Greene, San Francisco VA Medical Center, 4150 Clement Street, UCSF Box VA-181G, San Francisco, CA 94121. E-mail: meredith.greene@ucsf.edu

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  • Michael A. Steinman MD,

    1. Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
    2. San Francisco Veterans Affairs Medical Center, San Francisco, California
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  • Ian R. McNicholl PharmD,

    1. Positive Health Program, San Francisco General Hospital, University of California, San Francisco, San Francisco, California
    2. School of Pharmacy, University of California, San Francisco, San Francisco, California
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  • Victor Valcour MD, PhD

    1. Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
    2. Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, California
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Abstract

Objectives

To describe the frequency of medication-related problems in older adults with human immunodeficiency virus (HIV) infection.

Design

Retrospective chart review.

Setting

Community.

Participants

HIV-positive individuals aged 60 and older and age- and sex-matched HIV-negative individuals.

Measurements

Total number of medications, potentially inappropriate medications (PIMs) according to the modified Beers Criteria, anticholinergic drug burden according to the Anticholinergic Risk Scale (ARS), and drug–drug interactions using the Lexi-Interact online drug interactions database.

Results

Of 89 HIV-positive participants, most were Caucasian (91%) and male (94%), with a median age of 64 (range 60–82). Common comorbidities included hyperlipidemia, hypertension, and depression. Participants were taking a median of 13 medications (range 2–38), of which only a median of four were antiretrovirals. At least one PIM was prescribed in 46 participants (52%). Sixty-two (70%) participants had at least one Category D (consider therapy modification) drug–drug interaction, and 10 (11%) had a Category X (avoid combination) interaction. One-third of these interactions were between two nonantiretroviral medications. Fifteen participants (17%) had an ARS score of 3 or greater. In contrast, HIV-negative participants were taking a median of six medications, 29% had at least one PIM, and 4% had an ARS score of 3 or greater (P < .05 for each comparison, except P = .07 for anticholinergic burden).

Conclusion

HIV-positive older adults have a high frequency of medication-related problems, of which a large portion is due to medications used to treat comorbid diseases. These medication issues were substantially higher than HIV-negative participants. Attention to the principles of geriatric prescribing is needed as this population ages in order to minimize complications from multiple medication use.

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