Department of Pharmaceutical Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
J Antimicrob Chemother. 2022 Feb 2;77(2):492-499. doi: 10.1093/jac/dkab386.
Anticholinergic (ACH) medications have been associated with neurocognitive impairment, particularly in the elderly. This study determined prospectively the prevalence of prescribed ACH medications and their association with self-reported neurocognitive impairment (SRNI) in elderly people living with HIV (PLWH) of the Swiss HIV Cohort Study (SHCS).
A literature review was performed to identify ACH medications, which were scored 0 to 3 (higher score indicating more ACH burden). Prescriptions were reviewed in July 2019 for all SHCS participants ≥65 years old to assess the prevalence of ACH medications. Association between ACH burden and neurocognitive impairment was evaluated using the SHCS SRNI questions addressing memory loss, attention difficulties and slowing in reasoning.
One thousand and nineteen PLWH (82% male) with a median age of 70 (IQR = 67-74) years were included. Most participants were on ART (99%). The average number of non-HIV drugs was 5.1 ± 3.6, representing a polypharmacy prevalence of 50%. Two hundred participants (20%) were on ≥1 ACH medication, with an average ACH score of 1.7 ± 1.3. SRNI, adjusted for age, sex, CD4, nadir CD4, viral load, efavirenz use and polypharmacy, was associated with depression (OR = 4.60; 95% CI = 2.62-8.09) and a trend was observed with being on ≥1 ACH medication (OR = 1.69; 95% CI = 0.97-2.95). In a subgroup analysis of participants without depression (n = 911), SRNI was associated with the use of ≥1 ACH medication (OR = 2.51; 95% CI = 1.31-4.80).
ACH medication use is common in elderly PLWH and contributes to SRNI. The effect of ACH medications on neurocognitive impairment warrants further evaluation using neurocognitive tests.
抗胆碱能（ACH）药物与神经认知障碍有关，尤其是在老年人中。本研究前瞻性地确定了在瑞士艾滋病毒队列研究（SHCS）中接受抗胆碱能药物治疗的老年艾滋病毒感染者（PLWH）中，处方抗胆碱能药物的患病率及其与自我报告的神经认知障碍（SRNI）的相关性。
对文献进行了回顾，以确定抗胆碱能药物，这些药物的评分范围为 0 至 3（分数越高表示 ACH 负担越重）。2019 年 7 月，对所有≥65 岁的 SHCS 参与者的处方进行了审查，以评估抗胆碱能药物的使用情况。使用 SHCS 的 SRNI 问题评估 ACH 负担与神经认知障碍之间的相关性，这些问题涉及记忆力减退、注意力困难和推理速度减慢。
共纳入了 1019 名 PLWH（82%为男性），中位年龄为 70 岁（IQR=67-74）岁。大多数参与者接受了抗逆转录病毒治疗（99%）。平均使用的非 HIV 药物为 5.1±3.6 种，代表 50%的药物联合治疗。200 名参与者（20%）服用了≥1 种抗胆碱能药物，平均 ACH 评分为 1.7±1.3。SRNI 在调整了年龄、性别、CD4、CD4 最低点、病毒载量、依非韦伦使用和药物联合治疗后，与抑郁有关（OR=4.60；95%CI=2.62-8.09），与服用≥1 种抗胆碱能药物呈趋势相关（OR=1.69；95%CI=0.97-2.95）。在无抑郁（n=911）的参与者亚组分析中，SRNI 与使用≥1 种抗胆碱能药物相关（OR=2.51；95%CI=1.31-4.80）。
在老年 PLWH 中，抗胆碱能药物的使用很常见，并且与 SRNI 有关。抗胆碱能药物对神经认知障碍的影响需要进一步通过神经认知测试进行评估。
