1496. Evaluating the Effect of Polypharmacy on Outcomes in HIV-Infected Patients Age 50 and Older
Session: Poster Abstract Session: HIV Adherence
Friday, October 28, 2016
Room: Poster Hall
Posters
  • HIV Aging_ID Week_Poster_10.19.16_FINAL.pdf (115.9 kB)
  • Background: Polypharmacy is associated with older age, medication administration errors, increased hospitalizations, poorer adherence, and increases in drug-drug interactions. The efficacy, pharmacokinetics, adverse effects, and potential drug-drug interactions (DDIs) of ART in older adults have not been systematically studied. This study will investigate associations between polypharmacy and HIV virologic suppression and other outcomes in older HIV-infected adults.

    Methods: This, IRB approved, retrospective cohort study evaluated outcomes in HIV-infected patients aged ≥ 50 years as of 6/1/2013, on ART and seen at least once at the Northwestern Infectious Disease Center between 6/1/2013-5/31/2015. Data was collected from the most recent encounter for each patient. Eligible patients were stratified by number of prescribed medications: ≥10 versus <10 medications. The primary outcome was detectable vs non-detectable plasma HIV RNA level (viral load; undetectable defined as at least one value <20 IU/mL). Secondary outcomes included DDIs, CD4+ T-lymphocyte count (cells/mm3, CD4), taking medications on the Beers List (potentially inappropriate medications for elderly patients), and patient reported adverse drug effects.

    Results: One hundred patients were included (≤ 10 medications, n=65; >10 medications, n=35). Baseline characteristics were similar between groups. Patients taking >10 medications had lower median CD4 counts (351 vs 561 cells/mm3; p<0.01). Forty-eight patients taking ≤ 10 medications had a viral load <20 IU/mL compared to 21 participants on >10 medications (84.2% vs 67.7%, p=0.07). Patients taking >10 medications were more likely to report an adverse event (45.7% vs 26.5%, p=0.047), take medications on the Beers List (71.4% vs 41.5%; p<0.01), and report DDIs (94.3% vs 67.7%; p<0.01). All but one DDI was categorized as a “potential DDI” (79 of 80).

    Conclusion: Patients taking > 10 medications were no less likely to achieve HIV suppression than persons taking ≤ 10 medications; however, they were more likely to report a medication–related adverse effect. Further studies are needed to evaluate the impact of overall medication burden upon clinical outcomes in older HIV-infected persons.

    Michael L. Wilcox, PharmD1, Jessica Cottreau, PharmD1,2, Taylor Mancuso, PharmD Candidate3, Frank J. Palella Jr., MD4, Michael Postelnick, BS Pharm1 and Milena M. Mclaughlin, PharmD, MSc1,3, (1)Northwestern Memorial Hospital, Chicago, IL, (2)Rosalind Franklin University of Medicine and Science, North Chicago, IL, (3)Midwestern University Chicago College of Pharmacy, Downers Grove, IL, (4)Northwestern University Feinberg School of Medicine, Chicago, IL

    Disclosures:

    M. L. Wilcox, None

    J. Cottreau, None

    T. Mancuso, None

    F. J. Palella Jr., None

    M. Postelnick, None

    M. M. Mclaughlin, None

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