Freedman Samuel F, Johnston Carrie, Faragon John J, Siegler Eugenia L, Del Carmen Tessa
Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA.
Eur Geriatr Med. 2019;10(2):199-211. doi: 10.1007/s41999-018-0139-y. Epub 2018 Dec 6.
Polypharmacy is a well-described problem in the geriatric population. It is a relatively new problem for people living with HIV (PLWH), as this group now has a life expectancy approaching that of the general population. Defining polypharmacy for PLWH is difficult, since the most common traditional definition of at least five medications would encompass a large percentage of PLWH who are on antiretrovirals (ARVs) and medications for other medical comorbidities. Even when excluding ARVs, the prevalence of polypharmacy in PLWH is higher than the general population, and not just in resource-rich countries. Using a more nuanced approach with "appropriate" or "safer" polypharmacy allows for a better framework for discussing how to mitigate the associated risks. Some of the consequences of polypharmacy include adverse effects of medications including the risk of geriatric syndromes, drug-drug interactions, decreased adherence, and over- and undertreatment of medical comorbidities. Interventions to combat polypharmacy include decreasing pill burden-specifically with fixed-dose combination (FDC) tablets- and medication reconciliation/deprescription using established criteria. The goal of these interventions is to decrease drug interactions and improve quality of life and outcomes. Some special populations of interest within the community of PLWH include those with chronic pain, substance abuse, or requiring end of life care. A final look into the future of antiretroviral therapy (ART) shows the promise of possible two-drug regimens, which can help reduce the above risks of polypharmacy.
多重用药是老年人群中一个广为人知的问题。对于艾滋病毒感染者（PLWH）来说，这是一个相对较新的问题，因为这一群体现在的预期寿命已接近普通人群。为PLWH定义多重用药很困难，因为最常见的传统定义是至少服用五种药物，这将涵盖很大比例正在服用抗逆转录病毒药物（ARV）以及治疗其他合并症药物的PLWH。即使排除ARV，PLWH中多重用药的患病率也高于普通人群，而且不仅在资源丰富的国家如此。采用更细致入微的方法来定义“适当”或“更安全”的多重用药，可为讨论如何降低相关风险提供更好的框架。多重用药的一些后果包括药物的不良反应，包括老年综合征风险、药物相互作用、依从性降低以及合并症的过度治疗和治疗不足。应对多重用药的干预措施包括减轻 pill负担——特别是使用固定剂量复方（FDC）片剂——以及根据既定标准进行药物重整/减药。这些干预措施的目标是减少药物相互作用，提高生活质量和治疗效果。PLWH群体中一些值得关注的特殊人群包括患有慢性疼痛、药物滥用或需要临终关怀的人。最后展望抗逆转录病毒疗法（ART）的未来，有望出现可能的双药方案，这有助于降低上述多重用药风险。
