Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
HIV/AIDS Care Unit of Thammasat University Hospital, Pathumthani, Thailand.
Int J STD AIDS. 2020 Oct;31(12):1195-1201. doi: 10.1177/0956462420949798. Epub 2020 Sep 14.
Polypharmacy poses risks associated with drug-drug interactions, increased adverse effects, pill burden, poor compliance and unfavorable treatment outcomes. Whether polypharmacy affects treatment outcomes among people living with HIV (PLHIV) is largely unknown. A prospective study was conducted among PLHIV followed-up at a tertiary-care clinic of an academic medical center during January 2012 to December 2017. The clinic provided comprehensive HIV care with multidisciplinary team approach focusing on treatment adherence. Polypharmacy was defined as concurrent use of 5 or more non-antiretroviral (ARV) drugs for at least one year. Of the 248 PLHIV included, 23 (9%) received polypharmacy. PLHIV with polypharmacy were older (median age 45 vs. 36 years), were more likely to have underlying diseases (65% vs. 18%) and had lower median initial CD4 counts (40 vs. 214 cells/mm). The rates of virologic suppression at 12 months after ARV therapy were 96% and 92% in polypharmacy and non-polypharmacy groups, respectively (P = 0.70), while the median CD4 cell count increase was higher among the non-polypharmacy group at 12 months (207 vs. 403 cells/mm; P < 0.001). There were no differences in rates of adverse effects and experienced drug-drug interactions. Hospitalization due to HIV-related diseases within 12 months after ARV initiation [adjusted odds ratio (aOR) 11.63, P = 0.004] and lower 3-item score for ARV adherence (aOR 0.49, P = 0.01) were independently associated with failure of virologic suppression at 12 months. These findings suggest that polypharmacy did not affect the virological outcomes among our PLHIV. Patients with the characteristics associated with virological failure should be closely monitored.
同时使用 5 种或以上非抗逆转录病毒药物至少 1 年定义为同时使用多种药物。在 248 名接受调查的 HIV 感染者中，有 23 名（9%）接受了同时使用多种药物治疗。同时使用多种药物的 HIV 感染者年龄更大（中位数年龄 45 岁比 36 岁），更有可能患有基础疾病（65%比 18%），且初始 CD4 计数中位数更低（40 比 214 个细胞/mm）。接受抗逆转录病毒治疗 12 个月后，同时使用多种药物组和非同时使用多种药物组的病毒学抑制率分别为 96%和 92%（P=0.70），而非同时使用多种药物组在 12 个月时的 CD4 细胞计数增加中位数更高（207 比 403 个细胞/mm；P<0.001）。两组的不良反应发生率和药物相互作用发生率无差异。接受抗逆转录病毒治疗后 12 个月内因 HIV 相关疾病住院（校正比值比[aOR]11.63，P=0.004）和抗逆转录病毒药物治疗依从性 3 项评分较低（aOR 0.49，P=0.01）与 12 个月时病毒学抑制失败独立相关。这些发现表明，同时使用多种药物并未影响我们的 HIV 感染者的病毒学结果。应密切监测具有病毒学失败相关特征的患者。
