Krentz Hartmut B, Gill M John
1 Southern Alberta Clinic , Calgary, Alberta, Canada .
2 Department of Medicine, University of Calgary , Calgary, Alberta, Canada .
AIDS Patient Care STDS. 2016 Jan;30(1):11-7. doi: 10.1089/apc.2015.0199. Epub 2015 Nov 6.
Improved survival achieved by many patients with HIV/AIDS has complicated their medical care as increasing numbers of co-morbidities leads to polypharmacy, increased pill burdens, and greater risks of drug-drug interactions potentially compromising antiretroviral treatment (ART). We examined the impact of non-antiretroviral polypharmacy on ART for all adults followed at the Southern Alberta Clinic, Calgary, Canada. Polypharmacy was defined as ≥5 daily medications. We compared the impact of polypharmacy on continuous (i.e., remaining on same ART for ≥6 months) vs. non-continuous (i.e., discontinuing or switching ART) ART dosing frequency, number of ART pills, number of non-ART medications, and age. Of 1190 (89.5%) patients on ART, 95% were on three-drug regimens, 63.9% on QD ART, and 62% ≥3 ART pills daily; 32.2% were experiencing polypharmacy. Polypharmacy was associated with lower CD4, AIDS, >180 months living with HIV, higher numbers of ART pills, and older age (all p < 0.01); 32.1% stopped or switched ART. Polypharmacy increased the risk for non-continuous ART (36.8% vs. 30.0%; p < 0.01). Non-continuous ART increased with daily ART pill count but not increased age. Non-adherence and adverse effects accounted for the majority of non-continuous ART. We found a strong association between polypharmacy and non-continuous ART, potentially leading to effective ART being compromised. Collaborative approaches are needed to anticipate the negative impacts of polypharmacy.
许多感染艾滋病毒/艾滋病的患者生存状况的改善使他们的医疗护理变得复杂，因为越来越多的合并症导致了联合用药、药片负担增加以及药物相互作用风险加大，这可能会影响抗逆转录病毒治疗（ART）。我们研究了在加拿大卡尔加里的南艾伯塔诊所接受随访的所有成年患者中，非抗逆转录病毒联合用药对ART的影响。联合用药定义为每日服用≥5种药物。我们比较了联合用药对持续（即使用相同的ART≥6个月）与非持续（即停用或更换ART）ART给药频率、ART药片数量、非ART药物数量和年龄的影响。在1190名（89.5%）接受ART治疗的患者中，95%采用三联疗法，63.9%每日接受一次ART治疗，62%每日服用≥3片ART药片；32.2%的患者存在联合用药情况。联合用药与较低的CD4水平、艾滋病、感染艾滋病毒超过180个月、较高的ART药片数量和较高年龄相关（所有p<0.01）；32.1%的患者停止或更换了ART。联合用药增加了非持续ART的风险（36.8%对30.0%；p<0.01）。非持续ART随着每日ART药片数量的增加而增加，但与年龄增加无关。不依从和不良反应是导致非持续ART治疗的主要原因。我们发现联合用药与非持续ART之间存在密切关联，这可能会影响有效的ART治疗。需要采取协作方法来预测联合用药的负面影响。
