Hopwood-Raja Julian J, Tseng Alice L, Sheehan Nancy L, Walmsley Sharon L, Falutz Julian, Zhabokritsky Alice
Alberta Health Services, Kaye Edmonton Clinic, Edmonton.
University Health Network, Immunodeficiency Clinic.
AIDS. 2025 Nov 1;39(13):1898-1906. doi: 10.1097/QAD.0000000000004284. Epub 2025 Jun 27.
To characterize the prevalence of polypharmacy, use of potentially inappropriate medications (PIMs), anticholinergic burden (ACB), and sedative burden and their association with the risk of frailty and falls in a Canadian cohort of older people with HIV.
CHANGE-Rx is a cross-sectional analysis of baseline data from CHANGE-HIV, a prospective Canadian cohort of people with HIV aged 65 years and older.
Information on prescription, over-the-counter/natural-health product use, comorbidities, HIV-specific factors, frailty, and fall history were assessed at the baseline visit at cohort entry. Proportion of people with polypharmacy (≥5 non-antiretroviral drugs), severe polypharmacy (≥10 non-antiretroviral drugs), PIMs, ACB, and sedative burden were determined. Chi-square tests and multivariate regression analysis were used to assess the association between medication factors and the risk of frailty and falls.
Four hundred forty participants were included: median age 69 years (range: 65-89), 16.4% were classified as frail, 20.7% experienced a fall (last 6 months), 53.8% had polypharmacy, 14.6% had severe polypharmacy, 49.3% had at least one 1 PIM. For prescribed comedications, 16.5 and 55.7% of participants had high ACB and sedative burden, respectively. The odds ratios (ORs) for frailty were 3.3, 2.6, and 2.9 among patients with high ACB, high sedative burden, and severe polypharmacy, respectively. The OR for falls were 1.9 and 1.8 for patients with high sedative burden and at least one PIM, respectively.
Polypharmacy, PIMs, and high ACB and sedative burden are common among older adults with HIV in Canada. It remains to be determined if interventions addressing polypharmacy/PIMs would reduce falls and frailty.
描述多重用药、潜在不适当药物（PIM）的使用、抗胆碱能负担（ACB）和镇静负担的流行情况，以及它们与加拿大一组老年HIV感染者的衰弱和跌倒风险之间的关联。
CHANGE-Rx是对CHANGE-HIV队列研究基线数据的横断面分析，CHANGE-HIV是一项针对65岁及以上加拿大HIV感染者的前瞻性队列研究。
在队列入组时的基线访视中，评估处方、非处方/天然健康产品使用、合并症、HIV特异性因素、衰弱和跌倒史等信息。确定多重用药（≥5种非抗逆转录病毒药物）、严重多重用药（≥10种非抗逆转录病毒药物）、PIM、ACB和镇静负担人群的比例。采用卡方检验和多变量回归分析来评估药物因素与衰弱和跌倒风险之间的关联。
纳入440名参与者：年龄中位数为69岁（范围：65 - 89岁），16.4%被归类为衰弱，20.7%（过去6个月内）发生过跌倒，53.8%存在多重用药，14.6%存在严重多重用药，49.3%至少有一种PIM。对于处方的合并用药，分别有16.5%和55.7%的参与者有高ACB和镇静负担。高ACB、高镇静负担和严重多重用药患者发生衰弱的比值比（OR）分别为3.3、2.6和2.9。高镇静负担和至少有一种PIM的患者发生跌倒的OR分别为1.9和1.8。
在加拿大老年HIV感染者中，多重用药、PIM以及高ACB和镇静负担很常见。针对多重用药/PIM的干预措施是否能降低跌倒和衰弱风险仍有待确定。
