Polypharmacy increased mortality risk in patients with HIV
SAN FRANCISCO — The more medications that a patient with HIV takes, the higher the risk for all-cause mortality, according to research presented here at ID Week 2013.
“Polypharmacy, commonly defined as taking five or more medications, is a growing health care problem that is associated with increased costs and negative health outcomes,” E. Jennifer Edelman, MD, MHS, assistant professor of medicine at Yale University, said during her presentation. “It is more common among HIV-infected patients, despite potential for risk of harm, but there are limited data on polypharmacy among these patients.”
E. Jennifer Edelman
Edelman and colleagues conducted a cross-sectional analysis from 2009 to 2010. The study included patients with HIV who were identified through the Veterans Aging Cohort Study (VACS). They evaluated the effect of polypharmacy on mortality among patients who had been receiving antiretroviral therapy and among uninfected controls. Disease burden was measured using the VACS index.
The study sample included 47,613 patients without HIV and 16,989 patients with HIV and receiving ART. Among those with HIV, 56% were on four or more long-term medications compared with 65% of uninfected individuals. The most common medications, after ART medications in addition to their antiretroviral therapy, were antilipemic agents, angiotensin-converting enzyme inhibitors, gastric medications, antidepressants and beta-blockers. HIV-infected patients are less commonly prescribed these non-ART medications compared to uninfected patients after adjusting for demographics, VACS Index score and comorbid conditions.
After adjusting for demographics and the VACS Index score, mortality risk increased in a linear fashion among patients receiving 3 to 4, 5 to 7 or 8 or more medications, compared to those receiving less than 3 medications. This was true regardless of HIV status.
“Future studies examining longitudinal associations with polypharmacy and mortality and other health outcomes are warranted,” Edelman said. “The development and evaluation of interventions to reduce polypharmacy among HIV-infected patients are needed.”
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Disclosure: One researcher reports financial relationships with Gilead and Bristol-Myers Squibb.