Kim Jin, Nam Hyun-Ju, Kim Ji-Yeon, Heo Mi-Kyung, Shin Sung Un, Kim Uh Jin, Kim Seong Eun, Kang Seung-Ji, Bang Jihwan, Lee Jin-Soo, Jang Mi-Ok, Park Kyung-Hwa
Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Korea.
Department of Internal Medicine, Seoul Metropolitan Government Seoul Boramae Medical Center, Seoul, Korea.
Infect Chemother. 2024 Dec;56(4):534-543. doi: 10.3947/ic.2024.0132.
The life expectancy of people living with human immunodeficiency virus (PLWH) has significantly improved with advancements in antiretroviral therapy (ART). However, aging PLWH face a growing burden of non-communicable diseases (NCDs), polypharmacy, and drug-drug interactions (DDIs), which pose challenges in their management. This study investigates the prevalence of NCDs, polypharmacy, and DDIs among PLWH aged ≥50 years in Korea and their impact on quality of life (QOL).
A cross-sectional study was conducted among 243 PLWH aged ≥50 years receiving ART for at least three months at three university hospitals in Korea between January and July 2022. Data were collected through electronic medical records and personal interviews, assessing demographics, comorbidities, polypharmacy, ART adherence, and QOL using the Korean version of WHOQOL-HIV BREF scale. Potential DDIs were analyzed using the University of Liverpool HIV Drug Interaction Database, and potentially inappropriate medications (PIMs) were identified using the 2023 American Geriatrics Society Beers Criteria. We classified participants into three age groups: 50-<65 years, 65-<75 years, and ≥75 years.
The prevalence of comorbidities was 71.6%, with older participants (≥75 years) showing a significantly higher burden, including bone diseases, osteoarthritis, and dementia (<0.001). Polypharmacy was observed in 28.4% of participants and increased with age, with 53.3% of those aged ≥75 years taking ≥10 pills daily. Polypharmacy was associated with poorer QOL (71.6 76.6, =0.010). Amber-flag DDIs were found in 81 participants (33.3%), most commonly involving metformin and divalent cations. No red-flag DDIs were identified. PIMs were observed in 6.6% of participants aged ≥65 years.
Aging PLWH in Korea face significant challenges from comorbidities, polypharmacy, and DDIs, which negatively impact QOL. Integrated, age-specific, and multidisciplinary care strategies are urgently needed to improve outcomes and ensure the well-being of older PLWH.
随着抗逆转录病毒疗法（ART）的进步，人类免疫缺陷病毒感染者（PLWH）的预期寿命显著提高。然而，老年PLWH面临着日益加重的非传染性疾病（NCDs）、多重用药和药物相互作用（DDIs）负担，这给他们的管理带来了挑战。本研究调查了韩国≥50岁的PLWH中NCDs、多重用药和DDIs的患病率及其对生活质量（QOL）的影响。
2022年1月至7月期间，在韩国的三所大学医院对243名≥50岁且接受ART至少三个月的PLWH进行了一项横断面研究。通过电子病历和个人访谈收集数据，使用韩国版的WHOQOL-HIV BREF量表评估人口统计学、合并症、多重用药、ART依从性和QOL。使用利物浦大学HIV药物相互作用数据库分析潜在的DDIs，并使用2023年美国老年医学会Beers标准识别潜在不适当用药（PIMs）。我们将参与者分为三个年龄组：50-<65岁、65-<75岁和≥75岁。
合并症的患病率为71.6%，老年参与者（≥75岁）的负担明显更高，包括骨骼疾病、骨关节炎和痴呆（<0.001）。28.4%的参与者存在多重用药情况，且随年龄增加，≥75岁的参与者中有53.3%每天服用≥10片药。多重用药与较差的QOL相关（71.6 76.6，=0.010）。81名参与者（33.3%）发现有琥珀色警示DDIs，最常见的是二甲双胍和二价阳离子之间的相互作用。未发现红色警示DDIs。≥65岁的参与者中有6.6%观察到PIMs。
韩国老年PLWH面临合并症、多重用药和DDIs带来的重大挑战，这些对QOL有负面影响。迫切需要综合的、针对特定年龄的多学科护理策略，以改善结局并确保老年PLWH的健康。
