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Factors associated with polypharmacy and the prescription of multiple medications among persons living with HIV (PLWH) compared to non-PLWH.
AIDS Care 2015; 27(12):1443-8AC

Abstract

Persons living with HIV (PLWH) may be at increased risk for polypharmacy (≥5 concomitant medications) over non-PLWH, presumably due to antiretroviral therapy (ARV). Potential concerns associated with polypharmacy include clinically significant drug-drug interactions, adverse drug reactions, increased pill burden, and rising treatment-related costs. Our objective was to evaluate prescription of multiple non-ARV medications to PLWH, compared to non-PLWH, in US outpatient clinics and to identify factors associated with polypharmacy. Cross-sectional data from the 2006-2010 National Hospital Ambulatory Medical Care Survey were used for this study. Visits for PLWH were identified using HIV ICD9-CM codes 042, V08, and 079.53. Patients < 18 years of age were excluded. Relevant demographics included sex, age, race/ethnicity, and insurance status, while comorbid conditions included hypertension, diabetes, and hyperlipidemia. Multivariate logistic regression analyses evaluated factors independently associated with prescription of ≥ 5 medications. In total, 7,360,000 weighted visits for PLWH (13% aged 18-29 y; 55% aged 30-49 y; 32% aged ≥ 50 y) and 374,626,000 weighted visits for non-PLWH (18% aged 18-29 y; 32% aged 30-49 y; 50% aged ≥ 50 y) met study criteria. The greatest prevalence of hypertension, diabetes, and hyperlipidemia was in those ≥ 50 years of age (p < .001 for all comorbidities in PLWH and non-PLWH). In 2006, 16% of PLWH were prescribed ≥ 5 medications, doubling to 35% in 2010. In 2006, 24% of non-PLWH were prescribed ≥ 5 medications, only increasing to 32% in 2010. Older age (30-49 y and ≥ 50 y) was associated with ≥ 5 prescription medications in PLWH (adjusted odds ratio [aOR] = 2.538, 95% CI; 1.31-4.918 and aOR = 2.703, 95% CI; 1.678-4.354) and in non-PLWH (aOR = 2.546, 95% CI; 2.235-2.9 and aOR = 5.208, 95% CI; 4.486-6.047), respectively. Prescription of multiple medications is on the rise in PLWH, more so than in non-PLWH. Additional research is needed to explore how prescription of multiple medications differentially affects younger PLWH vs. older PLWH.

Authors+Show Affiliations

a UNC Eshelman School of Pharmacy, University of North Carolina , Chapel Hill , NC , USA.b Department of Biostatistics , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.a UNC Eshelman School of Pharmacy, University of North Carolina , Chapel Hill , NC , USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26608408

Citation

Moore, Heather N., et al. "Factors Associated With Polypharmacy and the Prescription of Multiple Medications Among Persons Living With HIV (PLWH) Compared to Non-PLWH." AIDS Care, vol. 27, no. 12, 2015, pp. 1443-8.
Moore HN, Mao L, Oramasionwu CU. Factors associated with polypharmacy and the prescription of multiple medications among persons living with HIV (PLWH) compared to non-PLWH. AIDS Care. 2015;27(12):1443-8.
Moore, H. N., Mao, L., & Oramasionwu, C. U. (2015). Factors associated with polypharmacy and the prescription of multiple medications among persons living with HIV (PLWH) compared to non-PLWH. AIDS Care, 27(12), pp. 1443-8. doi:10.1080/09540121.2015.1109583.
Moore HN, Mao L, Oramasionwu CU. Factors Associated With Polypharmacy and the Prescription of Multiple Medications Among Persons Living With HIV (PLWH) Compared to Non-PLWH. AIDS Care. 2015;27(12):1443-8. PubMed PMID: 26608408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with polypharmacy and the prescription of multiple medications among persons living with HIV (PLWH) compared to non-PLWH. AU - Moore,Heather N, AU - Mao,Lu, AU - Oramasionwu,Christine U, Y1 - 2015/11/26/ PY - 2015/11/27/entrez PY - 2015/11/27/pubmed PY - 2016/5/6/medline KW - HIV KW - antiretroviral therapy KW - comorbidities KW - older adults KW - polypharmacy SP - 1443 EP - 8 JF - AIDS care JO - AIDS Care VL - 27 IS - 12 N2 - Persons living with HIV (PLWH) may be at increased risk for polypharmacy (≥5 concomitant medications) over non-PLWH, presumably due to antiretroviral therapy (ARV). Potential concerns associated with polypharmacy include clinically significant drug-drug interactions, adverse drug reactions, increased pill burden, and rising treatment-related costs. Our objective was to evaluate prescription of multiple non-ARV medications to PLWH, compared to non-PLWH, in US outpatient clinics and to identify factors associated with polypharmacy. Cross-sectional data from the 2006-2010 National Hospital Ambulatory Medical Care Survey were used for this study. Visits for PLWH were identified using HIV ICD9-CM codes 042, V08, and 079.53. Patients < 18 years of age were excluded. Relevant demographics included sex, age, race/ethnicity, and insurance status, while comorbid conditions included hypertension, diabetes, and hyperlipidemia. Multivariate logistic regression analyses evaluated factors independently associated with prescription of ≥ 5 medications. In total, 7,360,000 weighted visits for PLWH (13% aged 18-29 y; 55% aged 30-49 y; 32% aged ≥ 50 y) and 374,626,000 weighted visits for non-PLWH (18% aged 18-29 y; 32% aged 30-49 y; 50% aged ≥ 50 y) met study criteria. The greatest prevalence of hypertension, diabetes, and hyperlipidemia was in those ≥ 50 years of age (p < .001 for all comorbidities in PLWH and non-PLWH). In 2006, 16% of PLWH were prescribed ≥ 5 medications, doubling to 35% in 2010. In 2006, 24% of non-PLWH were prescribed ≥ 5 medications, only increasing to 32% in 2010. Older age (30-49 y and ≥ 50 y) was associated with ≥ 5 prescription medications in PLWH (adjusted odds ratio [aOR] = 2.538, 95% CI; 1.31-4.918 and aOR = 2.703, 95% CI; 1.678-4.354) and in non-PLWH (aOR = 2.546, 95% CI; 2.235-2.9 and aOR = 5.208, 95% CI; 4.486-6.047), respectively. Prescription of multiple medications is on the rise in PLWH, more so than in non-PLWH. Additional research is needed to explore how prescription of multiple medications differentially affects younger PLWH vs. older PLWH. SN - 1360-0451 UR - https://www.unboundmedicine.com/medline/citation/26608408/Factors_associated_with_polypharmacy_and_the_prescription_of_multiple_medications_among_persons_living_with_HIV__PLWH__compared_to_non_PLWH_ L2 - http://www.tandfonline.com/doi/full/10.1080/09540121.2015.1109583 DB - PRIME DP - Unbound Medicine ER -