Clinical and demographic characteristics, and problems related to medication in patients with 50 or more years with recent diagnosis of HIV in Medellín, Colombia
DOI:
https://doi.org/10.17533/udea.iatreia.168Keywords:
Drug Interactions , HIV Infections , PolypharmacyAbstract
Introduction: multimorbidity, polypharmacy, and problems related to medication are common both, in aging people with HIV and in those diagnosed in advanced ages.
Objective: To describe the demographic, clinical characteristics, and problems related to medication in patients ≥ 50 years old with new diagnosis of HIV.
Methods: A descriptive transversal study. This study included patients ≥ 50-year-old, with new diagnosis of infection with HIV, who attended four HIV healthcare programs in the city of Medellín, Colombia, between January 2013 and December 2016.
Results: 493 patients were analyzed. 62.7% (n=309) were in WHO clinical stage 3. 49.5% (n=244) had at least one definitory condition of AIDS, with wasting syndrome (23.7%, n=117) and tuberculosis infections (16.8%, n=82) being the most frequent ones. At the time of diagnosis, the median of CD4 and viral load was 176 cells/mL (IQR 59-352) and 117,323 copies/mL (IQR 28,237-411,139), respectively. 59% (n=291) had non-infectious comorbidities, with the two most common being arterial hypertension (22.3%, n=110) and dyslipidemia (14.2%, n=70). 66.1% (n=326) of patients had problems related with medication, being the most frequent: drug interactions (61.1%, n=301), polypharmacy with ARV drugs (53.1%), potentially inappropriate medication (7.9%, n=39), and high anticholinergic risk (2.4%, n=12).
Conclusion: at the time of diagnosis, HIV-positive older adults frequently have multimorbidity, polypharmacy, and drug interactions. The diagnosis of HIV in this population is very delayed and the presence of opportunistic infections is frequent.
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(1) May MT, Gompels M, Delpech V, Porter K, Orkin C, Kegg S, et al. Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy. AIDS. 2014;28:1193–202. DOI 10.1097/QAD.0000000000000243.
(2) CDC. Diagnoses of HIV infection among adults aged 50 years and older in the United States and dependent areas, 2011–2016. HIV Surveill Suppl Rep. 2018;23.
(3) Caro-Vega Y, Belaunzarán-Zamudio PF, Crabtree-Ramírez B, Shepherd BE, Mejia F, Giganti MJ, et al. Trends in proportion of older HIV-infected people in care in Latin America and the Caribbean: a growing challenge. Epidemiol Infect. 2018;146:1308–11. DOI 10.1017/S0950268818001346.
(4) Cuellar NC. Informe de Evento VIH/SIDA. Colombia: Instituto Nacional de Salud, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública; 2019.
(5) Gross AM, Jaeger PA, Kreisberg JF, Licon K, Jepsen KL, Khosroheidari M, et al. Methylome-wide Analysis of Chronic HIV Infection Reveals Five-Year Increase in Biological Age and Epigenetic Targeting of HLA. Mol Cell. 2016;62:157–68. DOI 10.1016/j.molcel.2016.03.019.
(6) Rickabaugh TM, Kilpatrick RD, Hultin LE, Hultin PM, Hausner MA, Sugar CA, et al. The Dual Impact of HIV-1 Infection and Aging on Naïve CD4+ T-Cells: Additive and Distinct Patterns of Impairment. PLoS One. 2011;6:e16459. DOI 10.1371/journal.pone.0016459.
(7) Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, et al. Cross-sectional Comparison of the Prevalence of Age-Associated Comorbidities and Their Risk Factors Between HIV-Infected and Uninfected Individuals: The AGEhIV Cohort Study. Clin Infect Dis. 2014;59:1787–97. DOI 10.1093/cid/ciu701.
(8) Greene M, Steinman MA, McNicholl IR, Valcour V. Polypharmacy, Drug-Drug Interactions, and Potentially Inappropriate Medications in Older Adults with Human Immunodeficiency Virus Infection. J Am Geriatr Soc. 2014;62:447–53. DOI 10.1111/jgs.12695.
(9) hiv-druginteractions.org [internet]. Liverpool: HIV Drug Interactions, Interaction Checker; c2022. [citado 2022 Marzo 20]. Disponible en: https://www.hiv-druginteractions.org/
(10) Althoff KN, Gebo KA, Gange SJ, Klein MB, Brooks JT, Hogg RS, et al. CD4 count at presentation for HIV care in the United States and Canada: Are those over 50 years more likely to have a delayed presentation? AIDS Res Ther. 2010;7:45. DOI 10.1186/1742-6405-7-45.
(11) Mayorga LE. Informe de Evento VIH/SIDA. Colombia: Instituto Nacional de Salud, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública; 2021.
(12) Poorolajal J, Molaeipoor L, Mohraz M, Mahjub H, Ardekani MT, Mirzapour P, et al. Predictors of progression to AIDS and mortality post-HIV infection: a long-term retrospective cohort study. AIDS Care. 2015;27:1205–12. DOI 10.1080/09540121.2015.1045405.
(13) Althoff KN, Justice AC, Gange SJ, Deeks SG, Saag MS, Silverberg MJ, et al. Virologic and immunologic response to HAART, by age and regimen class. AIDS. 2010;24:2469–79. DOI 10.1097/QAD.0b013e32833e6d14.
(14) Dawood H, Hassan-Moosa R, Zuma N-Y, Naidoo K. Mortality and treatment response amongst HIV-infected patients 50 years and older accessing antiretroviral services in South Africa. BMC Infect Dis. 2018;18:168. DOI 10.1186/s12879-018-3083-z.
(15) Collaboration of Observational HIV Epidemiological Research Europe (COHERE) Study Group, Sabin CA, Smith CJ, d’Arminio Monforte A, Battegay M, Gabiano C, et al. Response to combination antiretroviral therapy: variation by age. AIDS. 2008;22:1463–73. DOI 10.1097/QAD.0b013e3282f88d02.
(16) Nice.org.uk [internet]. United Kingdom: National Institute for Health and Care Excellence; c2022 [citado 2022 Marzo 20]. Disponible en: https://www.nice.org.uk/guidance/ng56
(17) Guaraldi G, Orlando G, Zona S, Menozzi M, Carli F, Garlassi E, et al. Premature Age-Related Comorbidities Among HIV-Infected Persons Compared With the General Population. Clin Infect Dis. 2011;53:1120–6. DOI 10.1093/cid/cir627.
(18) Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, et al. Cross-sectional Comparison of the Prevalence of Age-Associated Comorbidities and Their Risk Factors Between HIV-Infected and Uninfected Individuals: The AGEhIV Cohort Study. Clin Infect Dis. 2014;59:1787–97. DOI 10.1093/cid/ciu701.
(19) Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–83. DOI 10.1016/0021-9681(87)90171-8.
(20) Holtzman C, Armon C, Tedaldi E, Chmiel JS, Buchacz K, Wood K, et al. Polypharmacy and Risk of Antiretroviral Drug Interactions Among the Aging HIV-Infected Population. J Gen Intern Med. 2013;28:1302–10. DOI 10.1007/s11606-013-2449-6.
(21) 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;47:1429–39. DOI 10.1177/1060028013504075.
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