Polypharmacy and frailty among persons with HIV

ABSTRACT

Polypharmacy is associated with frailty in the general population, but little is known about polypharmacy among persons living with HIV (PLWH) on antiretroviral (ARV) therapy. We determined the association between polypharmacy and an adapted frailty-related phenotype (aFRP) via a cross-sectional study in FY 2009 of 1762 PLWH on ARV with suppressed viral load and 2679 uninfected participants in the Veterans Aging Cohort Study. The primary predictor was number of chronic outpatient non-ARV medications using pharmacy fill/refill data. The outcome was self-report of four aFRP domains: shrinking, exhaustion, slowness, low physical activity. Frailty was defined as reporting 3–4 domains while pre-frailty was 1–2. Frailty was uncommon (2% PLWH, 3% uninfected); a larger proportion demonstrated any aFRP domain (31% PLWH, 41% uninfected). Among PLWH and uninfected, median chronic non-ARV medications was 6 and 16 respectively if having any aFRP domain, and 4 and 10 when without aFRP domains. In adjusted analyses, each additional chronic non-ARV medication conferred an 11% increased odds of having any aFRP domain in PLWH (OR [95% CI] = 1.11 [1.08, 1.14]), and a 4% increase in those uninfected (OR [95% CI] = 1.04 [1.03, 1.04]). The stronger association between polypharmacy and frailty in PLWH warrants further study and potential deprescribing of medications.

KEYWORDS:

• Polypharmacy
• frailty
• frail older adult
• HIV

Disclosure statement

No potential conflict of interest was reported by the authors.

Prior presentations

Society of General Internal Medicine Annual Meeting, Manchester Grand Hyatt Hotel, San Diego, CA, 24 April 2014, Oral presentation.

Additional information

Funding

This work was supported by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health [grants U24 AA020794, U01 AA020790 and U10 AA013566-completed]; Veterans Affairs Health Services Research and Development.