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The challenge of HIV treatment in an era of polypharmacy

INTRODUCTION: The availability of potent antiretroviral therapy has transformed HIV infection into a chronic disease such that people living with HIV (PLWH) have a near normal life expectancy. However, there are continuing challenges in managing HIV infection, particularly in older patients, who oft...

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Autores principales: Back, David, Marzolini, Catia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996317/
https://www.ncbi.nlm.nih.gov/pubmed/32011104
http://dx.doi.org/10.1002/jia2.25449
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author Back, David
Marzolini, Catia
author_facet Back, David
Marzolini, Catia
author_sort Back, David
collection PubMed
description INTRODUCTION: The availability of potent antiretroviral therapy has transformed HIV infection into a chronic disease such that people living with HIV (PLWH) have a near normal life expectancy. However, there are continuing challenges in managing HIV infection, particularly in older patients, who often experience age‐related comorbidities resulting in complex polypharmacy and an increased risk for drug‐drug interactions. Furthermore, age‐related physiological changes may affect the pharmacokinetics and pharmacodynamics of both antiretrovirals and comedications thereby predisposing elderly to adverse drug reactions. This review provides an overview of the therapeutic challenges when treating elderly PLWH (i.e. >65 years). Particular emphasis is placed on drug‐drug interactions and other common prescribing issues (i.e. inappropriate drug use, prescribing cascade, drug‐disease interaction) encountered in elderly PLWH. DISCUSSION: Prescribing issues are common in elderly PLWH due to the presence of age‐related comorbidities, organ dysfunction and physiological changes leading to a higher risk for drug‐drug interactions, drugs dosage errors and inappropriate drug use. CONCLUSIONS: The high prevalence of prescribing issues in elderly PLWH highlights the need for ongoing education on prescribing principles and the optimal management of individual patients. The knowledge of adverse health outcomes associated with polypharmacy and inappropriate prescribing should ensure that there are interventions to prevent harm including medication reconciliation, medication review and medication prioritization according to the risks/benefits for each patient.
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spelling pubmed-69963172020-02-05 The challenge of HIV treatment in an era of polypharmacy Back, David Marzolini, Catia J Int AIDS Soc Reviews INTRODUCTION: The availability of potent antiretroviral therapy has transformed HIV infection into a chronic disease such that people living with HIV (PLWH) have a near normal life expectancy. However, there are continuing challenges in managing HIV infection, particularly in older patients, who often experience age‐related comorbidities resulting in complex polypharmacy and an increased risk for drug‐drug interactions. Furthermore, age‐related physiological changes may affect the pharmacokinetics and pharmacodynamics of both antiretrovirals and comedications thereby predisposing elderly to adverse drug reactions. This review provides an overview of the therapeutic challenges when treating elderly PLWH (i.e. >65 years). Particular emphasis is placed on drug‐drug interactions and other common prescribing issues (i.e. inappropriate drug use, prescribing cascade, drug‐disease interaction) encountered in elderly PLWH. DISCUSSION: Prescribing issues are common in elderly PLWH due to the presence of age‐related comorbidities, organ dysfunction and physiological changes leading to a higher risk for drug‐drug interactions, drugs dosage errors and inappropriate drug use. CONCLUSIONS: The high prevalence of prescribing issues in elderly PLWH highlights the need for ongoing education on prescribing principles and the optimal management of individual patients. The knowledge of adverse health outcomes associated with polypharmacy and inappropriate prescribing should ensure that there are interventions to prevent harm including medication reconciliation, medication review and medication prioritization according to the risks/benefits for each patient. John Wiley and Sons Inc. 2020-02-03 /pmc/articles/PMC6996317/ /pubmed/32011104 http://dx.doi.org/10.1002/jia2.25449 Text en © 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Reviews
Back, David
Marzolini, Catia
The challenge of HIV treatment in an era of polypharmacy
title The challenge of HIV treatment in an era of polypharmacy
title_full The challenge of HIV treatment in an era of polypharmacy
title_fullStr The challenge of HIV treatment in an era of polypharmacy
title_full_unstemmed The challenge of HIV treatment in an era of polypharmacy
title_short The challenge of HIV treatment in an era of polypharmacy
title_sort challenge of hiv treatment in an era of polypharmacy
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996317/
https://www.ncbi.nlm.nih.gov/pubmed/32011104
http://dx.doi.org/10.1002/jia2.25449
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