Polypharmacy-associated risk of hospitalisation among people ageing with and without HIV: an observational study.
Polypharmacy-associated risk of hospitalisation among people ageing with and without HIV: an observational study.
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DOI：
10.1016/s2666-7568(21)00206-3
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发表时间：
2021-10
期刊：
影响因子：
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通讯作者：
Jacobson D
中科院分区：
文献类型：
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作者：
Justice AC;Gordon KS;Romero J;Edelman EJ;Garcia BJ;Jones P;Khoo S;Lo Re V 3rd;Rentsch CT;Tate JP;Tseng A;Womack J;Jacobson D
多重用药，定义为同时使用五种或五种以上的药物，与不良的健康结果有关，感染艾滋病毒的老年人可能比类似的未感染者面临更大的风险。我们的目的是确定已知的成对药物相互作用（KPDI）是否与住院（以下简称住院）的风险和药物计数在考虑到生理脆弱性后，与艾滋病毒感染者和非艾滋病毒感染者的年龄。在这项观察性研究中，我们收集了退伍军人老龄化队列研究（VACS）参与者的个人水平数据，这些参与者中有接受抗逆转录病毒治疗（ART）的艾滋病毒感染者和HIV-1 RNA受抑制者，以及接受至少一种处方药的无艾滋病毒感染者，基于2009财政年度（即2008年10月1日至2009年9月30日）的活性药物。我们通过将处方填写和补充数据与DrugBank（版本5.0.11）的数据相关联，确定了这些患者中的KPDI。我们收集了2009年10月1日至2019年3月31日期间的全因死亡率和住院数据。我们使用随机选择和实际使用模式比较了KPDI计数，药物计数从2到12。我们根据每个KPDI与无艾滋病毒老年人死亡率的平均相关性创建了加权KPDI指数，并使用按艾滋病毒状态分层的嵌套考克斯模型来估计药物计数与住院之间的相关性，并对人口统计学，生理虚弱和KPDI指数进行增量调整。我们收集了9186名艾滋病毒感染者和37930名未感染艾滋病毒者的数据。47116例患者中有45913例（97.4%）为男性，样本主要年龄为50-64岁（30413 [64.6%]）。与药物随机样本相比，药物计数和组合的真实世界模式与KPDI的5 - 6倍相关（例如，对于6种药物的组合，随机样本中的KPDI计数为1.09，HIV阴性人群为5.49，HIV阳性人群为7.13）。对于每增加一种观察到的药物，艾滋病毒老年人的KPDI增加约2.94，对照药物的KPDI增加约2.67。对人口统计学、生理虚弱和KPDI指数进行调整后，HIV感染者（风险比为1.08 [95% CI 1.07 - 1.09]，降低至1.06 [1.05 - 1.07]）和非HIV感染者（风险比为1.08 [1.07 - 1.08]，降低至1.04 [1.03 - 1.05]）的药物计数与住院风险之间的相关性降低。对于每一种额外的药物，艾滋病毒感染者比没有艾滋病毒的人有更多的药物相互作用。调整已知的非抗逆转录病毒药物相互作用，每增加一种非抗逆转录病毒药物都会给艾滋病毒老年人带来额外的住院风险。需要随机试验来确定减少这些相互作用是否会改善结果。美国国立卫生研究院、美国国立酒精滥用和酒精中毒研究所、退伍军人事务部卫生服务研究与发展部和研究与发展办公室。
Polypharmacy, defined as use of five or more medications concurrently, is associated with adverse health outcomes and people ageing with HIV might be at greater risk than similar uninfected individuals. We aimed to determine whether known pairwise drug interactions (KPDIs) were associated with risk of admission to hospital (hereafter referred to as hospitalisation) and medication count among people ageing with and without HIV after accounting for physiological frailty. In this observational study, we collected individual-level data for participants of the Veterans Aging Cohort Study (VACS) with HIV on antiretroviral therapy (ART) and with supressed HIV-1 RNA and people without HIV who were receiving at least one prescription medication, based on active medications in the 2009 fiscal year (ie, Oct 1, 2008, to Sept 30, 2009). We identified KPDIs among these patients by linking prescription fill and refill data with data from DrugBank (version 5.0.11). We collected data on all-cause mortality and hospitalisations between Oct 1, 2009, and March 31, 2019. We compared KPDI counts using random selection and actual patterns of use across medication counts from two to 12. We created a weighted KPDI Index on the basis of the average association of each KPDI with mortality among people ageing without HIV and used nested Cox models stratified by HIV status to estimate the association between medication count and hospitalisation, with incremental adjustments for demographics, physiological frailty, and KPDI Index. We collected data for 9186 people ageing with HIV and 37 930 individuals without HIV. 45 913 (97·4%) of 47 116 patients were men and the sample was predominantly aged 50–64 years (30 413 [64·6%]). Compared with a random sample of medications, real-world pattern of medication counts and combinations were associated with five-to-six times more KPDIs (eg, for a combination of six medications, KPDI count was 1·09 in the random sample, 5·49 in the HIV-negative population, and 7·13 in the HIV-positive population). For each additional observed medication, people ageing with HIV had approximately 2·94 additional KPDIs and comparators had approximately 2·67 additional KPDIs. Adjustment for demographics, physiological frailty, and KPDI Index reduced the association between medication count and risk of hospitalisation for people ageing with HIV (hazard ratio 1·08 [95% CI 1·07–1·09] reduced to 1·06 [1·05–1·07]) and those without HIV (1·08 [1·07–1·08] reduced to 1·04 [1·03–1·05]). For each additional medication, people ageing with HIV have more drug–drug interactions than those without HIV. Adjusting for known non-ART drug–drug interactions, each additional non-ART medication confers excess risk of hospitalisation for people ageing with HIV. Randomised trials will be needed to determine whether reducing these interactions improves outcomes. National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Department of Veterans Affairs Health Services Research & Development, and Office of Research and Development.