Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA.
Rutgers School of Public Health, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey, USA.
AIDS Patient Care STDS. 2023 Jun;37(6):297-305. doi: 10.1089/apc.2023.0008.
Improved life expectancy from advances in antiretroviral therapy (ART) has been followed by a rise in comorbidities and polypharmacy in this aging population. Historically, polypharmacy has been associated with suboptimal virologic outcomes in persons with HIV, although data in the current ART era and among historically marginalized populations in the United States are limited. We measured the prevalence of comorbidities and polypharmacy, evaluating their impact on virologic suppression. This retrospective IRB-approved cross-sectional study reviewed health records of adults with HIV on ART and receiving care (≥2 visits) in 2019 at a single center in a historically minoritized community. Virologic suppression (HIV RNA <200 copies/mL) based on polypharmacy (≥5 non-HIV medications) or multimorbidity (≥2 chronic conditions) was evaluated. Logistic regression analyses were performed to identify factors associated with virologic suppression, with age, race/ethnicity, and CD4 < 200 cells/mm as covariates. Of the 963 individuals that met the criteria, 67%, 47%, and 34% had ≥1 comorbidity, multimorbidity, and polypharmacy, respectively. The cohort demographics were: mean of 49 years (range, 18-81), 40% cisgender women, 46% Latinx individuals, 45% Black individuals, 8% White individuals. Virologic suppression rates were 95% among patients with polypharmacy compared with 86% in those with a lower pill burden ( = 0.0001). The odds of virologic success were higher for individuals with polypharmacy [adjusted odds ratio, aOR = 2.3 (95% confidence interval, CI: 1.2-4.4)] and Latinx identity [aOR = 2.4 (95% CI: 1.5-3.8)], but lower if a CD4 count <200 cells/mm [aOR = 0.07 (95% CI: 0.04-0.1)]. The comorbidity burden was higher than previously described, which are driving polypharmacy rates. In the current ART era, polypharmacy is not inherently associated with worse virologic outcomes.
抗逆转录病毒疗法 (ART) 的进步提高了预期寿命，但在这个老龄化人口中，合并症和多种药物治疗的情况有所增加。历史上，合并症和多种药物治疗与 HIV 患者的病毒学结果不理想有关，尽管在美国当前的 ART 时代和历史上边缘化人群中的数据有限。我们测量了合并症和多种药物治疗的患病率，评估了它们对病毒学抑制的影响。这项回顾性的机构审查委员会批准的横断面研究回顾了 2019 年在一个历史上处于少数群体社区的单一中心接受 ART 治疗并接受护理（≥2 次就诊）的成年人的健康记录。评估了基于多种药物治疗（≥5 种非 HIV 药物）或多种合并症（≥2 种慢性疾病）的病毒学抑制情况。进行了逻辑回归分析，以确定与病毒学抑制相关的因素，年龄、种族/族裔以及 CD4<200 个细胞/mm 作为协变量。在符合标准的 963 人中，分别有 67%、47%和 34%有≥1 种合并症、多种合并症和多种药物治疗。队列的人口统计学特征为：平均年龄为 49 岁（范围为 18-81 岁），40%为跨性别女性，46%为拉丁裔个体，45%为黑人个体，8%为白人个体。与低药物负担者（=0.0001）相比，多种药物治疗者的病毒学抑制率为 95%，而药物负担较低者为 86%。多种药物治疗者的病毒学成功几率更高[校正比值比（aOR）=2.3（95%置信区间，CI：1.2-4.4）]，拉丁裔身份者的几率更高[aOR=2.4（95%CI：1.5-3.8）]，而 CD4 计数<200 个细胞/mm 者的几率更低[aOR=0.07（95%CI：0.04-0.1）]。合并症负担高于以前的描述，这是导致多种药物治疗率增加的原因。在当前的 ART 时代，多种药物治疗本身并不一定会导致病毒学结果不理想。
