Polypharmacy and Polypathology: An Update From the 1st International Workshop on HIV & Aging

This is part of a series of articles summarizing presentations from the 1st International Workshop on HIV & Aging, which took place in Baltimore, Md., from Oct. 4 to Oct. 5, 2010. Jump to the table of contents to see the other articles in this series.

There were two presentations reviewing the increase in multiple health problems and the use of multiple medications among aging people with HIV.

Giovanni Guaraldi, M.D., gave a great presentation on the results from the CINECA cohort in Italy. The study group followed prescription drug use in 2,854 HIV-positive people and compared it to the prescription drug use of 8,562 HIV-negative controls who were matched by age, sex, race and geographical area. For people in the 50- to 60-year-old range, 20 percent of HIV-positive people had polypathology (more than one health condition besides HIV infection), compared to 6.6 percent of HIV-negative people.

The researchers found that HIV-positive people in the 40- to 50-year-old range had a similar polypatholohy to HIV-negative people in the 50- to 60-year-old range. Guaraldi thus estimated that HIV-positive people experience multiple health conditions that require prescriptions 10 to 15 years earlier than HIV-negative people. Polypathology became more likely among HIV-positive people if they were older, had a lower CD4 nadir (the lowest CD4 count a person ever had since being diagnosed with HIV) or were male.

The main medications used by aging HIV-positive people -- besides HIV medications, of course -- were gastrointestinal drugs (for diarrhea, heartburn, etc.), nervous system drugs (antidepressants and antiepileptics), antineoplastic agents (such as interferon for hepatitis C) and cardiovascular medications (blood pressure drugs, statins, etc.). Interestingly, HIV-positive people 51 to 60 years of age took seven pills a day on average, far more than the average of 0.11 pills a day for HIV-negative people.

These findings support growing concerns about the increased risk of drug-drug interactions as people with HIV age and begin take several medications to manage their other conditions. It is suggested that HIV pharmaceutical companies review the list of non-HIV drugs used by people with HIV and ensure that interaction studies are performed between antiretrovirals and commonly used non-HIV drugs.