Polypharmacy and drug-related problems among people living with HIV/AIDS: a singlecenter experience
Polypharmacy and drug-related problems among people living with HIV/AIDS: a singlecenter experience
Background/aim: The HIV-infected population is aging, and the concomitant comorbidities increase the likelihood of polypharmacy.There is a scarcity of data for determining drug-related problems in people living with HIV/AIDS (PLWHA).Materials and methods: This cross-sectional study was carried out between 1 September 2015 and 1 July 2016. All patients underwenta face-to-face interview with a clinical pharmacist. PCNE Classification V 7.0 was used classify incident drug-related problems (DRPs).Results: The mean age of the patients was 40.4 ± 13.06 years. The rate of polypharmacy was 66.1% in patients with comorbidities and12.3% in those without comorbidities (P < 0.001). DRPs were more prominent in older patients (46 vs. 37 years, P < 0.001), those withlonger durations of antiretroviral therapy (ART) (45 vs. 27 months, P = 0.014), and those with lower education levels (P = 0.013).Receiving >3 ART drugs was associated with more DRPs in the logistic regression model (odds ratio: 8.299, 95% confidence interval:1.924–35.803). Fifty-eight interventions were performed in 45 (24.9%) patients. Clinical pharmacist interventions were performed in18.9% of patients without polypharmacy and in 38.9% of patients with polypharmacy (P < 0.001).Conclusion: DRPs and polypharmacy are common among elderly PLWHA. More interventions are warranted to boost the quality oflife in aging PLWHA.
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- 1. Duyan V, Yildirim G. A brief picture of HIV/AIDS in Turkey.
AIDS Patient Care STDS 2003; 17: 373-375.
- 2. Marcus JL, Chao CR, Leyden WA, Xu L, Quesenberry CP Jr,
Klein DB, Towner WJ, Horberg MA, Silverberg MJ. Narrowing the gap in life expectancy between HIV-infected and HIVuninfected individuals with access to care. J Acquir Immune
Defic Syndr 2016; 73: 39-46.
- 3. Guaraldi G, Menozzi M, Zona S, Calcagno A, Silva AR, Santoro A, Malagoli A, Dolci G, Mussi C, Mussini C et al. Impact
of polypharmacy on antiretroviral prescription in people living
with HIV. J Antimicrob Chemother 2017; 72: 511-514.
- 4. Cantudo-Cuenca MR, Jimenez-Galan R, Almeida-Gonzalez
CV, Morillo-Verdugo R. Concurrent use of comedications reduces adherence to antiretroviral therapy among HIV-infected
patients. J Manag Care Spec Pharm 2014; 20: 844-850.
- 5. Edelman EJ, Gordon KS, Glover J, McNicholl IR, Fiellin DA,
Justice AC. The next therapeutic challenge in HIV: polypharmacy. Drugs Aging 2013; 30: 613-628.
- 6. Basger BJ, Moles RJ, Chen TF. Application of drug-related
problem (DRP) classification systems: a review of the literature. Eur J Clin Pharmacol 2014; 70: 799-815.
- 7. Hsu WT, Shen LJ, Lee CM. Drug-related problems vary with
medication category and treatment duration in Taiwanese
heart failure outpatients receiving case management. J Formos
Med Assoc 2016; 115: 335-342.
- 8. Kheshti R, Aalipour M, Namazi S. A comparison of five common drug-drug interaction software programs regarding accuracy and comprehensiveness. J Res Pharm Pract 2016; 5: 257-
263.
- 9. Sutaria A, Liu L, Ahmed Z. Multiple medication (polypharmacy) and chronic kidney disease in patients aged 60 and older: a
pharmacoepidemiologic perspective. Ther Adv Cardiovasc Dis
2016; 10: 242-250.
- 10. Eginger KH, Yarborough LL, Inge LD, Basile SA, Floresca D,
Aaronson PM. Medication errors in HIV-infected hospitalized
patients: a pharmacist’s impact. Ann Pharmacother 2013; 47:
953-960.
- 11. Pastakia SD, Corbett AH, Raasch RH, Napravnik S, Correll
TA. Frequency of HIV-related medication errors and associated risk factors in hospitalized patients. Ann Pharmacother
2008; 42: 491-497.
- 12. Erlandson KM, Allshouse AA, Jankowski CM, Duong S,
MaWhinney S, Kohrt WM, Campbell TB. Risk factors for falls
in HIV-infected persons. J Acquir Immune Defic Syndr 2012;
61: 484-489.
- 13. Marzolini C, Back D, Weber R, Furrer H, Cavassini M, Calmy
A, Vernazza P, Bernasconi E, Khoo S, Battegay M et al. Ageing
with HIV: medication use and risk for potential drug-drug interactions. J Antimicrob Chemother 2011; 66: 2107-2111.
- 14. Nachega JB, Hsu AJ, Uthman OA, Spinewine A, Pham PA. Antiretroviral therapy adherence and drug-drug interactions in
the aging HIV population. AIDS 2012; 26: S39-S53.
- 15. Krentz HB, Cosman I, Lee K, Ming JM, Gill MJ. Pill burden in
HIV infection: 20 years of experience. Antivir Ther 2012; 17:
833-840.
- 16. Holtzman C, Armon C, Tedaldi E, Chmiel JS, Buchacz K,
Wood K, Brooks JT; HOPS Investigators. Polypharmacy and
risk of antiretroviral drug interactions among the aging HIVinfected population. J Gen Intern Med 2013; 28: 1302-1310.
- 17. Tseng A, Szadkowski L, Walmsley S, Salit I, Raboud J. Association of age with polypharmacy and risk of drug interactions
with antiretroviral medications in HIV-positive patients. Ann
Pharmacother 2013; 47: 1429-1439.
- 18. Molino Cde G, Carnevale RC, Rodrigues AT, Visacri MB,
Moriel P, Mazzola PG. Impact of pharmacist interventions on
drug-related problems and laboratory markers in outpatients
with human immunodeficiency virus infection. Ther Clin Risk
Manag 2014; 10: 631-639.
- 19. Silveira MP, Guttier MC, Page K, Moreira LB. Randomized
controlled trial to evaluate the impact of pharmaceutical care
on therapeutic success in HIV-infected patients in Southern
Brazil. AIDS Behav 2014; 18: S75-S84.
- 20. Foisy MM, Akai PS. Pharmaceutical care for HIV patients on
directly observed therapy. Ann Pharmacother 2004; 38: 550-
556.
- 21. Walji N, Beardsell A, Brown G. Pharmacists’ activities in
monitoring zidovudine therapy in an AIDS clinic. Can J Hosp
Pharm 1992; 45: 29-32.
- 22. Bozek PS, Perdue BE, Bar-Din M, Weidle PJ. Effect of pharmacist interventions on medication use and cost in hospitalized patients with or without HIV infection. Am J Health Syst
Pharm 1998; 55: 1151-1155.
- 23. Carcelero E, Tuset M, Martin M, De Lazzari E, Codina C, Miro
J, Gatell J. Evaluation of antiretroviral-related errors and interventions by the clinical pharmacist in hospitalized HIV-infected patients. HIV Med 2011; 12: 494-499.
- 24. Billedo JA, Berkowitz LB, Cha A. Evaluating the impact of a
pharmacist-led antiretroviral stewardship program on reducing drug interactions in HIV-infected patients. J Int Assoc
Provid AIDS Care 2016; 15: 84-88.
- 25. Ojeh VB, Naima N, Abah IO, Falang KD, Lucy O, London I,
Dady C, Agaba P, Agbaji O. Pattern of drug therapy problems
and interventions in ambulatory patients receiving antiretroviral therapy in Nigeria. Pharm Pract (Granada) 2015; 13: 566.