title: Polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults with human immunodeficiency virus infection.
abstract: OBJECTIVE
  To describe the frequency of medication-related problems in older adults with human immunodeficiency virus (HIV) infection.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Community.
  
  
  METHODS
  HIV-positive individuals aged 60 and older and age- and sex-matched HIV-negative individuals.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California; San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Meredith
authors.initials: M
authors.lastname: Greene
authors.forename: Michael A
authors.initials: MA
authors.lastname: Steinman
authors.forename: Ian R
authors.initials: IR
authors.lastname: McNicholl
authors.forename: Victor
authors.initials: V
authors.lastname: Valcour
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D004347:Drug Interactions; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents
keywords: HIV infection; drug interactions; inappropriate prescribing; polypharmacy