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老龄化 HIV 感染人群中,多种药物并用与抗逆转录病毒药物相互作用的风险。

Polypharmacy and risk of antiretroviral drug interactions among the aging HIV-infected population.

机构信息

Temple University School of Pharmacy, 3307 N. Broad St., Philadelphia, PA, 19140, USA,

出版信息

J Gen Intern Med. 2013 Oct;28(10):1302-10. doi: 10.1007/s11606-013-2449-6. Epub 2013 Apr 20.

Abstract

BACKGROUND

Among aging HIV-infected adults, polypharmacy and its consequences have not been well-described.

OBJECTIVE

To characterize the extent of polypharmacy and the risk of antiretroviral (ARV) drug interactions among persons of different ages.

DESIGN AND PARTICIPANTS

Cross-sectional analysis among patients within the HIV Outpatient Study (HOPS) cohort who were prescribed ARVs during 2006-2010.

MAIN MEASURES

We used the University of Liverpool HIV drug interactions database to identify ARV/non-ARV interactions with potential for clinical significance.

KEY RESULTS

Of 3,810 patients analyzed (median age 46 years, 34 % ≥ 50 years old) at midpoint of observation, 1,494 (39 %) patients were prescribed ≥ 5 non-ARV medications: 706 (54 %) of 1,312 patients ≥ 50 years old compared with 788 (32 %) of 2,498 patients < 50 years. During the five-year period, the number of patients who were prescribed at least one ARV/non-ARV combination that was contraindicated or had moderate or high evidence of interaction was 267 (7 %) and 1,267 (33 %), respectively. Variables independently associated with having been prescribed a contraindicated ARV/non-ARV combination included older age (adjusted odds ratio [aOR] per 10 years of age 1.17, 95 % CI 1.01-1.35), anxiety (aOR 1.78, 95 % CI 1.32-2.40), dyslipidemia (aOR 1.96, 95 % CI 1.28-2.99), higher daily non-ARV medication burden (aOR 1.13, 95 % CI 1.10-1.17), and having been prescribed a protease inhibitor (aOR 2.10, 95 % CI 1.59-2.76). Compared with patients < 50 years, older patients were more likely to have been prescribed an ARV/non-ARV combination that was contraindicated (unadjusted OR 1.44, 95 % CI 1.14-1.82), or had moderate or high evidence of interaction (unadjusted OR 1.29, 95 % CI 1.15-1.44).

CONCLUSIONS

A substantial percentage of patients were prescribed at least one ARV/non-ARV combination that was contraindicated or had potential for a clinically significant interaction. As HIV-infected patients age and experience multiple comorbidities, systematic reviews of current medications by providers may reduce risk of such exposures.

摘要

背景

在老龄化的 HIV 感染者中,药物的联合使用及其后果尚未得到充分描述。

目的

描述不同年龄段人群中药物联合使用的程度和抗逆转录病毒(ARV)药物相互作用的风险。

设计和参与者

对 2006 年至 2010 年期间在 HIV 门诊研究(HOPS)队列中接受 ARV 治疗的患者进行了横断面分析。

主要措施

我们使用利物浦大学 HIV 药物相互作用数据库来识别具有潜在临床意义的 ARV/非 ARV 相互作用。

主要结果

在观察中点分析了 3810 名患者(中位年龄 46 岁,34%≥50 岁),其中 1494 名(39%)患者服用了≥5 种非 ARV 药物:1312 名≥50 岁的患者中有 706 名(54%),2498 名<50 岁的患者中有 788 名(32%)。在五年期间,至少有一种被处方的 ARV/非 ARV 联合用药被认为是禁忌或具有中度或高度证据的相互作用的患者人数分别为 267 名(7%)和 1267 名(33%)。与被处方禁忌的 ARV/非 ARV 联合用药相关的变量包括年龄较大(每增加 10 岁的调整优势比[OR]为 1.17,95%置信区间[CI]为 1.01-1.35)、焦虑(OR 1.78,95%CI 为 1.32-2.40)、血脂异常(OR 1.96,95%CI 为 1.28-2.99)、更高的每日非 ARV 药物负担(OR 1.13,95%CI 1.10-1.17)和接受蛋白酶抑制剂治疗(OR 2.10,95%CI 为 1.59-2.76)。与<50 岁的患者相比,年龄较大的患者更有可能被处方禁忌的 ARV/非 ARV 联合用药(未调整的 OR 1.44,95%CI 为 1.14-1.82)或具有中度或高度证据的相互作用(未调整的 OR 1.29,95%CI 为 1.15-1.44)。

结论

相当一部分患者被处方了至少一种禁忌或具有潜在临床意义相互作用的 ARV/非 ARV 联合用药。随着 HIV 感染者年龄的增长和多种合并症的出现,提供者对当前药物进行系统审查可能会降低此类药物暴露的风险。

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