The next therapeutic challenge in HIV: polypharmacy.
The next therapeutic challenge in HIV: polypharmacy.
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DOI：
10.1007/s40266-013-0093-9
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发表时间：
2013-08
期刊：
影响因子：
2.8
通讯作者：
Justice AC
中科院分区：
文献类型：
--
作者：
Edelman EJ;Gordon KS;Glover J;McNicholl IR;Fiellin DA;Justice AC
随着联合抗逆转录病毒疗法（ART）的采用，大多数接受治疗的艾滋病毒感染者都在服用五种或五种以上的药物，并面临多种药物的危害风险，这种风险可能会随着药物数量，年龄和生理虚弱而增加。多种药物治疗的既定危害包括药物依从性降低和严重药物不良事件增加，包括器官系统损伤、住院、老年综合征（福尔斯、骨折和认知能力下降）和死亡率。文献中的艾滋病毒感染者之间的多药治疗是有限的，和文献中的非艾滋病毒患者之间的多药治疗需要适应的特殊问题所面临的慢性ART。首先，那些老龄化的艾滋病毒感染者往往开始ART在他们的第三或第四个十年的生活，并预计将继续对ART的余生。其次，艾滋病毒感染者可能有更高的风险患上与年龄相关的共病，进一步增加了他们多药治疗的风险。第三，由于器官系统储备减少、慢性炎症和持续的免疫功能障碍，艾滋病毒感染者可能对多种药物的伤害更敏感。最后，由于ART可以延长生命，因此不坚持ART尤其令人担忧。在回顾相关文献后，我们提出了一个适应性框架，以解决终身ART中的多药治疗问题，并为未来的工作提出了建议。
With the adoption of combination antiretroviral therapy (ART), most HIV-infected individuals in care are on five or more medications and at risk of harm from polypharmacy, a risk that likely increases with number of medications, age, and physiologic frailty. Established harms of polypharmacy include decreased medication adherence and increased serious adverse drug events, including organ system injury, hospitalization, geriatric syndromes (falls, fractures, and cognitive decline) and mortality. The literature on polypharmacy among those with HIV infection is limited, and the literature on polypharmacy among non-HIV patients requires adaptation to the special issues facing those on chronic ART. First, those aging with HIV infection often initiate ART in their 3rd or 4th decade of life and are expected to remain on ART for the rest of their lives. Second, those with HIV may be at higher risk for age-associated comorbid disease, further increasing their risk of polypharmacy. Third, those with HIV may have an enhanced susceptibility to harm from polypharmacy due to decreased organ system reserve, chronic inflammation, and ongoing immune dysfunction. Finally, because ART is life-extending, nonadherence to ART is particularly concerning. After reviewing the relevant literature, we propose an adapted framework with which to address polypharmacy among those on lifelong ART and suggest areas for future work.
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影响因子：
2.9
作者：
Anthierens S;Tansens A;Petrovic M;Christiaens T
通讯作者：
Christiaens T
DOI：
10.1007/s11524-011-9552-y
发表时间：
2011-06-01
影响因子：
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作者：
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通讯作者：
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DOI：
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发表时间：
2004-04-01
期刊：
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影响因子：
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作者：
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通讯作者：
Clay, Patrick G
影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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