Ageing with HIV: prescribing errors ‘common’

20 March 2020

New review suggests that between 50% and 70% of older people living with HIV are being prescribed drugs in error, highlighting treatment challenges for this population.

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In an overview published in the Journal of the International AIDS Society last month, researchers examined data on HIV-positive over 65-year-olds to see how polypharmacy (the use of multiple medications to treat more than one illness or health condition) affects this age group.

People living with HIV accessing effective antiretroviral treatment (ART) now have near-normal life expectancy. What’s more, it’s predicted that one in four people living with HIV will be aged over 60 by 2030, of which one-third will be living with an additional illness (known as a ‘co-morbidity’). Despite this, data on this group is limited because older people are often excluded from clinical HIV trials.

The review also looked at how age-related physiological changes, such as declines in liver mass and blood flow, may affect the way the body reacts to medication, as well as the effects of medication on the body, as people age.

Several studies reported a higher prevalence of multiple co-morbidities among older people living with HIV, compared to HIV-negative people of the same age.

Linked to this, multiple medication use is common among older HIV-positive people, ranging between 15% and 94% among those aged 50 and over.

Several large studies found multiple medication use to be more common among HIV-positive people than HIV-negative people across various different age groups. However, this difference was less obvious as people aged, possibly reflecting the fact that chronic diseases are more likely to occur as people get older, regardless of their HIV status.

The risk of being caught in a harmful ‘prescription cascade’ is higher for older people living with HIV. A prescription cascade describes a situation whereby the use of multiple medications leads to an adverse drug reaction, which is then misinterpreted as a new disease, leading to unnecessary medication being prescribed.

This, in turn, can cause a further adverse drug reaction, leading to the prescription of more unnecessary drugs. To date, only three studies have assessed the extent of prescribing errors in relation to older people living with HIV. These found between 52% and 69% of HIV-positive people aged 65 and over have been prescribed inappropriate medications.

Older people living with HIV are more susceptible to adverse drug-to-drug reactions resulting from age‐related physiological changes than their HIV-negative counterparts, and may also be more at-risk if they have been on long-term ART using older, more toxic regimens.

The overview indicates that older people on ART are likely to experience significant issues due to the additional medications they are being prescribed. It also clearly highlights the need to enable health professionals to develop a better understanding of treatment management for older people living with HIV. Strategies include education on key drug-drug interactions in relation to each class of antiretroviral drugs. Medication reviews and dosage adjustments, based on the risk to, and benefits for, the individual are also important avenues for medical professionals to explore. Decisions should take into account care goals, remaining life expectancy, an individual’s current level of functioning and a patient’s personal treatment preferences.

There is also a need for more real‐world studies that examine the risks associated with various forms of polypharmacy and drug-drug interactions to help guide better treatment management for older people living with HIV.

Written by Hester Phillips