4CPS-083 Aging with HIV: optimising pharmacotherapy beyond interactions

BackgroundPharmacotherapeutic complexity and potentially inappropriate medication (PIM) negatively affect therapeutic goals in HIV +adult patients and increase frailty and risk of falls. The POINT study carried out in Spain in 2017 alerted polypharmacy and pharmacotherapeutic complexity, and low adherence in HIV +adults.PurposeTo describe treatment complexity, fall-risk-increasing drugs (FRIDs) burden, and the presence of PIM in middle-aged and elderly HIV +patients in our clinical setting.Material and methodsObservational, cross-sectional study was conducted in the referral hospital for HIV infection of our region in April 2018. We selected patients aged ≥45 y. Exclusion criteria: no medication information available in electronic clinical history. Age, gender and active chronic medication were collected. We calculated: overall treatment complexity and complexity due to concomitant one (MRCI-E tool); FRIDs with the most consistent association with a higher risk (antipsychotics, antidepressants, benzodiazepines, loop diuretics, opioids, antiepileptics and polypharmacy, according to the Systematic Review and Meta-Analysis of the EUGMS Task and Finish Group on FRIDs); anticholinergic drug burden (DBI score); and STOPP criteria. Polypharmacy was defined as ≥5 medications. Fix-dose combinations were counted as one drug.ResultsA total of 143 HIV +patients were included, all of them on antirretroviral treatment (ART), 92.3% received concomitant non-HIV drugs (non-ART). Median age: 54y (SD 7.6; range 45 to 84y) and 94 (65.7%) male. Eighty-two patients (57.3%) received ≥1 FRID (35.7%≥1 benzodiazepine), 71 (49.7%) had ≥1 anticholinergic drug and at least one STOPP criteria was detected in 55 patients (38.4%).Abstract 4CPS-083 Table 1 Pharmacological profile N (%) Median (SD) Range Total chronic drugs (ART+non ART)1434 (3.1)1–17 ART 143 (100%) 2 (0.9) 1– 5 Non-ART 132 (92.3%) 3 (2.8) 1– 14 ≥5 non-ART 40 (28%) 7 (2.3) 5– 14Overall complexity (ART+non ART) (points)1438 (7.1)2–38.5 ART complexity 143 3 (1.6) 2– 12.5 Non-ART complexity 132 5 (6.6) 0.5– 32 % non-ART complexity/overall 132 63.6% (19.9) 11.1%– 94 %Number of FRIDs/patient82 (57.3%)2 (1.1)1–5 Benzodiazepine 51 (35.7%) 1 (0.4) 1– 2Anticholinergic drug burden (DBI points)71 (49.7%)0.75 (0.7)0.2–3.46 High-risk DBI score (≥1 ) 33 (23.1%) 1.58 (0.5) 1.05– 3.46Number of STOPP criteria55 (38.5%)1 (0.6)1–3ConclusionThe impact of non-HIV drugs on overall pharmacotherapeutic complexity, and the frequent use of PIM in p