Kosana Priya, Wu Kunling, Tassiopoulos Katherine, Letendre Scott, Ma Qing, Paul Robert, Ellis Ronald, Erlandson Kristine M, Farhadian Shelli F
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA.
Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
Clin Infect Dis. 2024 Jun 14;78(6):1608-1616. doi: 10.1093/cid/ciad782.
Older people with human immunodeficiency virus (HIV, PWH) are prone to using multiple medications due to higher rates of medical comorbidities and the use of antiretroviral therapy (ART). We assessed the prevalence and clinical impact of polypharmacy among PWH.
We leveraged clinical data from the AIDS Clinical Trials Group A5322 study "Long-Term Follow-up of Older HIV-infected Adults: Addressing Issues of Aging, HIV Infection and Inflammation" (HAILO). We included PWH aged ≥40 years with plasma HIV RNA levels <200 copies/µL. We assessed the relationship between polypharmacy (defined as the use of 5 or more prescription medications, excluding ART) and hyperpolypharmacy (defined as the use of 10 or more prescription medications, excluding ART) with slow gait speed (less than 1 meter/second) and falls, including recurrent falls.
Excluding ART, 24% of study participants had polypharmacy and 4% had hyperpolypharmacy. Polypharmacy was more common in women (30%) than men (23%). Participants with polypharmacy had a higher risk of slow gait speed (odds ratio [OR] = 1.78; 95% confidence interval [CI] = 1.27-2.50) and increased risk of recurrent falls (OR = 2.12; 95% CI = 1.06-4.23). The risk for recurrent falls was further increased in those with hyperpolypharmacy compared with those without polypharmacy (OR = 3.46; 95% CI = 1.32-9.12).
In this large, mixed-sex cohort of PWH aged ≥40 years, polypharmacy was associated with slow gait speed and recurrent falls, even after accounting for medical comorbidities, alcohol use, substance use, and other factors. These results highlight the need for increased focus on identifying and managing polypharmacy and hyperpolypharmacy in PWH.
感染人类免疫缺陷病毒（HIV）的老年人（HIV感染者，PWH）由于合并症发生率较高以及使用抗逆转录病毒疗法（ART），往往会使用多种药物。我们评估了PWH中多重用药的患病率及其临床影响。
我们利用了艾滋病临床试验组A5322研究“老年HIV感染成人的长期随访：解决衰老、HIV感染和炎症问题”（HAILO）的临床数据。我们纳入了年龄≥40岁、血浆HIV RNA水平<200拷贝/微升的PWH。我们评估了多重用药（定义为使用5种或更多处方药，不包括ART）和超多重用药（定义为使用10种或更多处方药，不包括ART）与步态速度缓慢（小于1米/秒）和跌倒（包括反复跌倒）之间的关系。
不包括ART，24%的研究参与者存在多重用药，4%存在超多重用药。多重用药在女性（30%）中比男性（23%）更常见。存在多重用药的参与者步态速度缓慢的风险更高（优势比[OR]=1.78；95%置信区间[CI]=1.27-2.50），反复跌倒的风险增加（OR=2.12；95%CI=1.06-4.23）。与没有多重用药的人相比，超多重用药的人反复跌倒的风险进一步增加（OR=3.46；95%CI=1.32-9.12）。
在这个年龄≥40岁的大型、男女混合的PWH队列中，即使在考虑了合并症、饮酒、药物使用和其他因素后，多重用药仍与步态速度缓慢和反复跌倒有关。这些结果凸显了在PWH中加强对多重用药和超多重用药的识别与管理的必要性。
