POLYPHARMACY AND ANTIRETROVIRAL THERAPY IN THE AGING HIV-INFECTED POPULATION: A NEW CHALLENGE

Introduction : Potent and well tolerated highly active antiretroviral therapies (HAART) have increased life expectancy of HIV population with 50% of the patients over 50 years in 2015. Comorbidities and polypharmacy have been associated with increasing age,increasing risk of adverse drug reactions (ADR), increased hospitalization rates, adherence issues, misuse and drug-drug interactions. Objective : To evaluate and describe the toxicity associated with HAART in the elderly population. Methods: All ADR associated with a suspected HAART in the elderly population (65- year-old patients or over) were collected on the French Pharmacovigilance Database from 01/01/2005 to 12/31/2015. After sorting the data according to System Organ Class, the rate of ADR was calculated. Severity, outcome, patient characteristics and comorbidities were also collected. Results : 319 notifications with ADR were reviewed, among them 159 were serious. The median age was 68 years (range 65–107) with 26% women. Most frequent clinical side effects were skin and subcutaneous tissue disorders (n= 77-15.3 %), renal and urinary disorders (n= 77-15.3 %) and gastrointestinal disorders (n= 56-11.1 %). Nucleoside (or nucleotidic) Reverse Transcriptase Inhibitor- and Protease Inhibitor-including regimens were the most frequent suspected regimens associated with ADRs. Opportunistic infections and comorbidities such as hypertension, diabetes, hyperlipidemia were mainly identified, with 6 or more concomitant medications notified in this context. Conclusion : This investigation provides a background for subsequent management and understanding of how to optimize the care of these patients that have an increased risk of polypharmacy with medical treatments associated with chronic diseases added to HAART.