Cargando…
Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals
BACKGROUND: HIV-positive individuals (HIV+) on antiretrovirals commonly take enough other medications to cross a threshold for polypharmacy but little is known about associated outcomes. We asked whether non-antiretroviral polypharmacy is associated with hospitalization and mortality and whether ass...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868488/ https://www.ncbi.nlm.nih.gov/pubmed/29543653 http://dx.doi.org/10.1097/QAD.0000000000001756 |
_version_ | 1783309144659329024 |
---|---|
author | Justice, Amy C. Gordon, Kirsha S. Skanderson, Melissa Edelman, Eva Jennifer Akgün, Kathleen M. Gibert, Cynthia L. Lo Re, Vincent Rimland, David Womack, Julie A. Wyatt, Christina M. Tate, Janet P. |
author_facet | Justice, Amy C. Gordon, Kirsha S. Skanderson, Melissa Edelman, Eva Jennifer Akgün, Kathleen M. Gibert, Cynthia L. Lo Re, Vincent Rimland, David Womack, Julie A. Wyatt, Christina M. Tate, Janet P. |
author_sort | Justice, Amy C. |
collection | PubMed |
description | BACKGROUND: HIV-positive individuals (HIV+) on antiretrovirals commonly take enough other medications to cross a threshold for polypharmacy but little is known about associated outcomes. We asked whether non-antiretroviral polypharmacy is associated with hospitalization and mortality and whether associations differ by HIV status. METHODS: Data on HIV+ and uninfected individuals in the US Veterans Affairs Healthcare System were analyzed. Eligible HIV+ were on antiretrovirals with suppressed HIV-1 RNA and uninfected individuals received at least one medication. We calculated average non-antiretroviral medication count for fiscal year 2009. As there is no established threshold for non-antiretroviral polypharmacy, we considered more than two and at least five medications. We followed for hospitalization and mortality (fiscal year 2010–2015), adjusting for age, sex, race/ethnicity and VACS Index. RESULTS: Among 9473 HIV+ and 39 812 uninfected individuals respectively, non-antiretroviral polypharmacy was common (>2: 67, 71%; ≥5: 34, 39%). VACS Index discriminated risk of hospitalization (c-statistic: 0.62, 0.60) and mortality (c-statistic: 0.72, 0.70) similarly in both groups. After adjustment, more than two (hazard ratio 1.51, 95% CI 1.46–1.55) and at least five non-antiretrovirals (hazard ratio 1.52, 95% CI 1.49–1.56) were associated with hospitalization with no interaction by HIV status. Risk of mortality associated with more than two non-antiretrovirals interacted with HIV status (P = 0.002), but not for at least five (adjusted hazard ratio 1.43, 95% CI 1.36–1.50). For both groups and both outcomes, average medication count demonstrated an independent, dose response, association. CONCLUSION: Neither severity of illness nor demographics explain a dose response, association of non-antiretroviral polypharmacy with adverse health outcomes among HIV+ and uninfected individuals. |
format | Online Article Text |
id | pubmed-5868488 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-58684882018-07-11 Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals Justice, Amy C. Gordon, Kirsha S. Skanderson, Melissa Edelman, Eva Jennifer Akgün, Kathleen M. Gibert, Cynthia L. Lo Re, Vincent Rimland, David Womack, Julie A. Wyatt, Christina M. Tate, Janet P. AIDS Clinical Science BACKGROUND: HIV-positive individuals (HIV+) on antiretrovirals commonly take enough other medications to cross a threshold for polypharmacy but little is known about associated outcomes. We asked whether non-antiretroviral polypharmacy is associated with hospitalization and mortality and whether associations differ by HIV status. METHODS: Data on HIV+ and uninfected individuals in the US Veterans Affairs Healthcare System were analyzed. Eligible HIV+ were on antiretrovirals with suppressed HIV-1 RNA and uninfected individuals received at least one medication. We calculated average non-antiretroviral medication count for fiscal year 2009. As there is no established threshold for non-antiretroviral polypharmacy, we considered more than two and at least five medications. We followed for hospitalization and mortality (fiscal year 2010–2015), adjusting for age, sex, race/ethnicity and VACS Index. RESULTS: Among 9473 HIV+ and 39 812 uninfected individuals respectively, non-antiretroviral polypharmacy was common (>2: 67, 71%; ≥5: 34, 39%). VACS Index discriminated risk of hospitalization (c-statistic: 0.62, 0.60) and mortality (c-statistic: 0.72, 0.70) similarly in both groups. After adjustment, more than two (hazard ratio 1.51, 95% CI 1.46–1.55) and at least five non-antiretrovirals (hazard ratio 1.52, 95% CI 1.49–1.56) were associated with hospitalization with no interaction by HIV status. Risk of mortality associated with more than two non-antiretrovirals interacted with HIV status (P = 0.002), but not for at least five (adjusted hazard ratio 1.43, 95% CI 1.36–1.50). For both groups and both outcomes, average medication count demonstrated an independent, dose response, association. CONCLUSION: Neither severity of illness nor demographics explain a dose response, association of non-antiretroviral polypharmacy with adverse health outcomes among HIV+ and uninfected individuals. Lippincott Williams & Wilkins 2018-03-27 2018-04-04 /pmc/articles/PMC5868488/ /pubmed/29543653 http://dx.doi.org/10.1097/QAD.0000000000001756 Text en Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | Clinical Science Justice, Amy C. Gordon, Kirsha S. Skanderson, Melissa Edelman, Eva Jennifer Akgün, Kathleen M. Gibert, Cynthia L. Lo Re, Vincent Rimland, David Womack, Julie A. Wyatt, Christina M. Tate, Janet P. Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals |
title | Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals |
title_full | Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals |
title_fullStr | Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals |
title_full_unstemmed | Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals |
title_short | Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals |
title_sort | nonantiretroviral polypharmacy and adverse health outcomes among hiv-infected and uninfected individuals |
topic | Clinical Science |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868488/ https://www.ncbi.nlm.nih.gov/pubmed/29543653 http://dx.doi.org/10.1097/QAD.0000000000001756 |
work_keys_str_mv | AT justiceamyc nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals AT gordonkirshas nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals AT skandersonmelissa nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals AT edelmanevajennifer nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals AT akgunkathleenm nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals AT gibertcynthial nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals AT lorevincent nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals AT rimlanddavid nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals AT womackjuliea nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals AT wyattchristinam nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals AT tatejanetp nonantiretroviralpolypharmacyandadversehealthoutcomesamonghivinfectedanduninfectedindividuals |