76. HIV+ Individuals on ART Are At Risk of Polypharmacy: More Medication Increases Mortality
Session: Oral Abstract Session: HIV: Treatment, Complications, and Outcomes
Thursday, October 3, 2013: 9:00 AM
Room: The Moscone Center: 250-262
Background: Among general medical patients, polypharmacy (defined as > 5 medications) predicts adverse drug events and nonadherence.  However, observational research on polypharmacy has been limited due to confounding by indication and sample size.   Using the Veterans Aging Cohort Study (VACS), we characterized polypharmacy and its association with mortality among HIV-infected (HIV+) individuals on ART and uninfected (HIV-) controls. We accounted for disease burden with the VACS Index, a validated measure of organ system dysfunction, which predicts mortality. 

Methods: Cross-sectional analysis from 2009 to 2010 including HIV+ with > 12 months of ART and HIV-.  VACS Index was calculated based on labs closest to the midpoint of the period.  Medications were determined using electronic pharmacy fill/refill data available and were considered individually and by class using established VHA classes.  Combination pills were separated into their components.  Multivariable Cox proportional hazards models were used to adjust for mortality risk and adjusted hazard ratios were plotted by number of medications. 

Results: Of HIV+ on ART, 64% were on 5 or more medications (42% of HIV-).  After antiretrovirals, the next 5 most common medication classes were antilipemic agents, antidepressants, ACE inhibitors, beta blockers, and gastric medications.   Age, HIV status, white race, alcohol and substance use disorders, psychiatric disorders, medical diagnoses, and VACS Index scores were associated with polypharmacy.  Mortality risk was linearly associated with number of medications crossing significance (p=0.03) at 6 or more.  With each medication beyond five, risk of mortality increased 10% in unadjusted and 5% in adjusted analyses.  Those on > 5 medications had a 30% higher risk of mortality after adjusting for VACS Index scores (HR 1.30, 95% CI 1.16-1.44); this risk was higher among HIV+ (HR 1.39, 95% CI 1.11-1.73).   

Conclusion: These findings demonstrate increased risk of all-cause mortality associated with polypharmacy among a national sample of veterans with HIV.  While adjustment for VACS Index helps address concern that observational data is confounded by indication, these findings support the need for the development and evaluation of interventions aimed at reducing polypharmacy among those aging with HIV.

E. Jennifer Edelman1, Kirsha Gordon2, Kathleen Akgun1, Cynthia Gibert, MD, MSc3, Vincent Lo Re4, Ian McNicholl, PharmD, BCPS, AAHIVE5, David Rimland, MD6, Janet P. Tate, MPH7, Julie Womack8, Christina M. Wyatt, MD9 and Amy C. Justice, MD, PhD10, (1)Yale University, New Haven, CT, (2)Connecticut Healthcare System, West Haven, CT, (3)Washington, DC, VAMC, Washington, DC, (4)University of Pennsylvania, Philadelphia, PA, (5)University of California at San Francisco, San Francisco, CA, (6)VA Medical Center, Decatur, GA, (7)VA Connecticut Healthcare System, West Haven, CT, (8)Yale University School of Nursing, New Haven, CT, (9)Mount Sinai School of Medicine, New York, NY, (10)Yale University and VA Connecticut Healthcare System, West Haven, CT

Disclosures:

E. J. Edelman, None

K. Gordon, None

K. Akgun, None

C. Gibert, None

V. Lo Re, None

I. McNicholl, None

D. Rimland, None

J. P. Tate, None

J. Womack, None

C. M. Wyatt, Gilead Sciences: Grant Investigator, Grant recipient, Investigator-initiated award as a subcontract to MSSM and Research support
BMS: , Paid through a third party, Healthclear Strategies and Speaker honorarium

A. C. Justice, None

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