在澳大利亚接受抑制性抗逆转录病毒疗法的成年人中，同时服用多种药物、药物相互作用和不完全遵医嘱的情况很常见。
Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy.
机构信息
aSt Vincent's Centre for Applied Medical Research, St Vincent's Hospital, SydneybCentre for Social Research in HealthcNeuroscience Research Australia, University of New South Wales, SydneydNational Association of People with HIV Australia, NewtowneSchool of Public Health and Community Medicine, University of New South Wales, Sydney, New South WalesfDepartment of Infectious Diseases, Alfred Hospital and Monash UniversitygDepartment of Infectious Diseases, The Royal Women's HospitalhMonash Infectious Diseases, Monash Health, Melbourne, VictoriaiAlbion Centre, South Eastern Sydney Local Hospital Network, Sydney, New South WalesjCentre for Population Health, Burnet InstitutekMelbourne Sexual Health Centre, Alfred HealthlCentral Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VictoriamWestern Sydney Sexual Health Centre, University of Sydney, ParramattanWestmead Clinical School, Sydney Medical School, University of Sydney, Westmead, New South WalesoCentre Clinic, St Kilda, Melbourne, VictoriapHoldsworth House Medical PracticeqThe Kirby Institute, University of New South Wales, Sydney, New South Wales, AustraliarDepartment of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands.
出版信息
AIDS. 2018 Jan 2;32(1):35-48. doi: 10.1097/QAD.0000000000001685.
OBJECTIVES
We quantified concomitant medication polypharmacy, pharmacokinetic and pharmacodynamic interactions, adverse effects and adherence in Australian adults on effective antiretroviral therapy.
DESIGN
Cross-sectional.
METHODS
Patients recruited into a nationwide cohort and assessed for prevalence and type of concomitant medication (including polypharmacy, defined as ≥5 concomitant medications), pharmacokinetic or pharmacodynamic interactions, potential concomitant medication adverse effects and concomitant medication adherence. Factors associated with concomitant medication polypharmacy and with imperfect adherence were identified using multivariable logistic regression.
RESULTS
Of 522 participants, 392 (75%) took a concomitant medication (mostly cardiovascular, nonprescription or antidepressant). Overall, 280 participants (54%) had polypharmacy of concomitant medications and/or a drug interaction or contraindication. Polypharmacy was present in 122 (23%) and independently associated with clinical trial participation, renal impairment, major comorbidity, hospital/general practice-based HIV care (versus sexual health clinic) and benzodiazepine use. Seventeen participants (3%) took at least one concomitant medication contraindicated with their antiretroviral therapy, and 237 (45%) had at least one pharmacokinetic/pharmacodynamic interaction. Concomitant medication use was significantly associated with sleep disturbance and myalgia, and polypharmacy of concomitant medications with diarrhoea, fatigue, myalgia and peripheral neuropathy. Sixty participants (12%) reported imperfect concomitant medication adherence, independently associated with requiring financial support, foregoing necessities for financial reasons, good/very good self-reported general health and at least 1 bed day for illness in the previous 12 months.
CONCLUSION
In a resource-rich setting with universal healthcare access, the majority of this sample took a concomitant medication. Over half had at least one of concomitant medication polypharmacy, pharmacokinetic or pharmacodynamic interaction. Concomitant medication use was associated with several adverse clinical outcomes.
目的
我们定量评估了澳大利亚接受有效抗逆转录病毒治疗的成年人同时使用多种药物的情况、药物的药代动力学和药效学相互作用、不良反应和用药依从性。
设计
横断面研究。
方法
招募了参与全国性队列研究的患者，评估同时使用药物的情况（包括同时使用≥5 种药物的药物联用）、药代动力学或药效学相互作用、潜在的药物不良反应和药物依从性。使用多变量逻辑回归确定与药物联用及不依从治疗相关的因素。
结果
522 名参与者中，392 名（75%）同时使用了一种药物（主要是心血管、非处方或抗抑郁药）。总体而言，280 名参与者（54%）存在药物联用及/或药物相互作用或禁忌证。药物联用的发生率为 122 名（23%），与参与临床试验、肾功能损害、主要合并症、在医院/普通科诊所（而非性健康诊所）就诊以及使用苯二氮䓬类药物有关。17 名（3%）参与者至少同时使用了一种与抗逆转录病毒治疗禁忌的药物，237 名（45%）至少存在一种药代动力学/药效学相互作用。药物联用与睡眠障碍和肌痛显著相关，药物联用且同时使用多种药物与腹泻、疲劳、肌痛和周围神经病显著相关。60 名（12%）参与者报告药物依从性不完整，与需要经济支持、因经济原因放弃生活必需品、自我报告的总体健康状况良好/非常好以及过去 12 个月中至少有 1 天因疾病卧床有关。
结论
在一个资源丰富、全民医疗保健覆盖的环境中，大多数患者同时使用了一种以上的药物。超过一半的患者至少有一种药物联用、药代动力学或药效学相互作用。药物联用与多种不良临床结局有关。
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