Prevalence of medication overload among older people with HIV: a MedSafer study
Abstract Background Older people with HIV (PWH) are at risk of polypharmacy (taking multiple medications). Most medications may be necessary and indicated to manage HIV (e.g., antiretroviral therapy [ART]) and HIV-associated comorbidities. However, some are potentially inappropriate medications (PIM...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-10-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-024-10105-9 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850203901372923904 |
|---|---|
| author | Émilie Bortolussi-Courval Elizabeth Smyth Cecilia Costiniuk Julian Falutz Sydney B. Ross Kathy Liu Jimin J. Lee Nancy L. Sheehan Todd C. Lee Emily G. McDonald |
| author_facet | Émilie Bortolussi-Courval Elizabeth Smyth Cecilia Costiniuk Julian Falutz Sydney B. Ross Kathy Liu Jimin J. Lee Nancy L. Sheehan Todd C. Lee Emily G. McDonald |
| author_sort | Émilie Bortolussi-Courval |
| collection | DOAJ |
| description | Abstract Background Older people with HIV (PWH) are at risk of polypharmacy (taking multiple medications). Most medications may be necessary and indicated to manage HIV (e.g., antiretroviral therapy [ART]) and HIV-associated comorbidities. However, some are potentially inappropriate medications (PIMs), defined as causing greater harm than benefit, which leads to medication overload. The objective of this study was to characterize polypharmacy (taking multiple medications) and medication overload (prescription of ≥ 1 PIMs) among older PWH. Methods This retrospective study included older PWH (aged ≥ 50 years old) attending the tertiary care HIV clinic at the McGill University Health Centre (Montreal, Canada), from June 2022–June 2023. Patient characteristics, medications, and select laboratory values (e.g., CD4 count, hemoglobin A1C) were entered into the MedSafer software identifying PIMs and classifying them according to risk of adverse drug event. We measured the prevalence of polypharmacy (≥ 5 medications prescribed, both including and excluding ART) and medication overload (≥ 1 PIMs). Multivariable logistic regression identified factors associated with medication overload. Results The study included 100 patients, with a median age of 59 years (IQR = 54–63; range 50–82); 42% female. Polypharmacy affected 89% of patients when including antiretroviral therapy (ART) and 60% when excluding ART. Medication overload was present in 58% of patients, and 37.4% of identified PIMs were classified as high-risk. Polypharmacy was the sole predictor of medication overload. Conclusion Older PWH are at significant risk of medication overload and receiving higher risk PIMs. Deprescribing PIMs in this population could improve medication appropriateness while reducing the risk of ADEs. |
| format | Article |
| id | doaj-art-63c0d5ea98f24e7682d1a3436d7be257 |
| institution | OA Journals |
| issn | 1471-2334 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-63c0d5ea98f24e7682d1a3436d7be2572025-08-20T02:11:24ZengBMCBMC Infectious Diseases1471-23342024-10-0124111010.1186/s12879-024-10105-9Prevalence of medication overload among older people with HIV: a MedSafer studyÉmilie Bortolussi-Courval0Elizabeth Smyth1Cecilia Costiniuk2Julian Falutz3Sydney B. Ross4Kathy Liu5Jimin J. Lee6Nancy L. Sheehan7Todd C. Lee8Emily G. McDonald9Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill UniversityCanadian Medication Appropriateness and Deprescribing NetworkDivision of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill UniversityChronic Viral Illness Service, McGill University Health CentreDepartment of Medicine, Faculty of Medicine and Health Sciences, McGill UniversityCanadian Medication Appropriateness and Deprescribing NetworkDivision of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill UniversityChronic Viral Illness Service, McGill University Health CentreDivision of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill UniversityDivision of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill UniversityAbstract Background Older people with HIV (PWH) are at risk of polypharmacy (taking multiple medications). Most medications may be necessary and indicated to manage HIV (e.g., antiretroviral therapy [ART]) and HIV-associated comorbidities. However, some are potentially inappropriate medications (PIMs), defined as causing greater harm than benefit, which leads to medication overload. The objective of this study was to characterize polypharmacy (taking multiple medications) and medication overload (prescription of ≥ 1 PIMs) among older PWH. Methods This retrospective study included older PWH (aged ≥ 50 years old) attending the tertiary care HIV clinic at the McGill University Health Centre (Montreal, Canada), from June 2022–June 2023. Patient characteristics, medications, and select laboratory values (e.g., CD4 count, hemoglobin A1C) were entered into the MedSafer software identifying PIMs and classifying them according to risk of adverse drug event. We measured the prevalence of polypharmacy (≥ 5 medications prescribed, both including and excluding ART) and medication overload (≥ 1 PIMs). Multivariable logistic regression identified factors associated with medication overload. Results The study included 100 patients, with a median age of 59 years (IQR = 54–63; range 50–82); 42% female. Polypharmacy affected 89% of patients when including antiretroviral therapy (ART) and 60% when excluding ART. Medication overload was present in 58% of patients, and 37.4% of identified PIMs were classified as high-risk. Polypharmacy was the sole predictor of medication overload. Conclusion Older PWH are at significant risk of medication overload and receiving higher risk PIMs. Deprescribing PIMs in this population could improve medication appropriateness while reducing the risk of ADEs.https://doi.org/10.1186/s12879-024-10105-9HIVOlder adultsPolypharmacyPotentially inappropriate medicationsDeprescribing |
| spellingShingle | Émilie Bortolussi-Courval Elizabeth Smyth Cecilia Costiniuk Julian Falutz Sydney B. Ross Kathy Liu Jimin J. Lee Nancy L. Sheehan Todd C. Lee Emily G. McDonald Prevalence of medication overload among older people with HIV: a MedSafer study BMC Infectious Diseases HIV Older adults Polypharmacy Potentially inappropriate medications Deprescribing |
| title | Prevalence of medication overload among older people with HIV: a MedSafer study |
| title_full | Prevalence of medication overload among older people with HIV: a MedSafer study |
| title_fullStr | Prevalence of medication overload among older people with HIV: a MedSafer study |
| title_full_unstemmed | Prevalence of medication overload among older people with HIV: a MedSafer study |
| title_short | Prevalence of medication overload among older people with HIV: a MedSafer study |
| title_sort | prevalence of medication overload among older people with hiv a medsafer study |
| topic | HIV Older adults Polypharmacy Potentially inappropriate medications Deprescribing |
| url | https://doi.org/10.1186/s12879-024-10105-9 |
| work_keys_str_mv | AT emiliebortolussicourval prevalenceofmedicationoverloadamongolderpeoplewithhivamedsaferstudy AT elizabethsmyth prevalenceofmedicationoverloadamongolderpeoplewithhivamedsaferstudy AT ceciliacostiniuk prevalenceofmedicationoverloadamongolderpeoplewithhivamedsaferstudy AT julianfalutz prevalenceofmedicationoverloadamongolderpeoplewithhivamedsaferstudy AT sydneybross prevalenceofmedicationoverloadamongolderpeoplewithhivamedsaferstudy AT kathyliu prevalenceofmedicationoverloadamongolderpeoplewithhivamedsaferstudy AT jiminjlee prevalenceofmedicationoverloadamongolderpeoplewithhivamedsaferstudy AT nancylsheehan prevalenceofmedicationoverloadamongolderpeoplewithhivamedsaferstudy AT toddclee prevalenceofmedicationoverloadamongolderpeoplewithhivamedsaferstudy AT emilygmcdonald prevalenceofmedicationoverloadamongolderpeoplewithhivamedsaferstudy |