Ageing with HIV: Medicine Optimisation Challenges and Support Needs for Older People Living with HIV: A Systematic Review

Drugs & Aging, Journal Year: 2023, Volume and Issue: 40(3), P. 179 - 240

Published: Jan. 20, 2023

Older people living with HIV (PLWH) are at increased risks of co-morbidities and polypharmacy. However, little is known about factors affecting their needs concerns medicines. This systematic review aims to describe these identify interventions improve medicine optimisation outcomes in older PLWH. Multiple databases grey literature were searched from inception February 2022 including MEDLINE, CINAHL, PsycInfo, PsychArticles, the Cochrane Database Systematic Reviews Controlled Register Trials, Abstracts Social Gerontology, Academic Search Complete. Studies reporting interventions/issues PLWH (sample populations mean/median age ≥ 50 years; any aspect optimisation, or concerns). Quality assessments completed by means critical appraisal checklists for each study design. Title abstract screening was led one reviewer a sample reviewed independently two reviewers. Full-paper reviews author 20% Data extracted three independent reviewers using standardised data extraction forms synthesised according reported. summarised include key themes, concerns, summary intervention. Seventy-nine (n = 79) studies met eligibility criteria, most which originated USA 36). A few Australia 5), Canada Spain 9), UK 5). Ten Sub-Saharan Africa (Kenya n 1, South 6, Tanzania Uganda Zimbabwe 1). The rest China 1), France Germany Italy Netherlands Pakistan Switzerland Saudi Arabia 1) Ukraine Publication dates ranged 2002 2022. Sample sizes 10 15,602 across studies. PLWH's experience issues medicines co-morbidities, health-related quality life, polypharmacy, drug interactions, adverse reactions, adherence, burden, treatment stigma, social support, patient-healthcare provider relationships. Nine identified target persons, five aimed improving medication reduce self-management initiatives. Further in-depth research needed understand experiences priority issues. Adherence-focused predominant, but there scarcity this population. Multi-faceted achieve registered PROSPERO registration number: CRD42020188448.

Language: Английский

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The impact of medication regimen complexity on patient-related and clinical outcomes in kidney failure: a systematic review

Expert Opinion on Pharmacotherapy, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 9

Published: Jan. 7, 2025

Introduction Kidney failure is a life-limiting condition that profoundly impacts an individual's quality of life. The significant medication burden on patients required to manage the comorbidities and complications kidney can have implications for patient-reported clinical outcomes.

Language: Английский

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Real-life data of immune recovery using bictegravir/emtricitabine/tenofovir alafenamide in virologically suppressed people living with HIV. Results at 48–96 weeks of RETROBIC Study

Journal of Antimicrobial Chemotherapy, Journal Year: 2024, Volume and Issue: 79(3), P. 595 - 607

Published: Jan. 24, 2024

Abstract Background Switching strategy with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) has become a gold standard for people living HIV (PLWH), achieving high efficacy and safety rates. However, data regarding immune status in long-term real-life cohorts of pretreated patients are needed. Methods We performed multicentre, non-controlled, retrospective study virologically suppressed PLWH switching to B/F/TAF. evaluated CD4+, CD8+ CD4+/CD8+ ratio, at weeks 48 96. Results The comprised 1966 from 12 hospitals Spain, whom 80% were men, the median age was 51.0 [42.0–57.0] years. time infection 18.0 [10.0–27.0] No significant changes T cells, or observed after 96 weeks. Nevertheless, women 96, we found increase CD4+ cells decrease cells. In ≥60 years week CD4 significantly increased decreased 48. on-treatment analysis revealed HIV-RNA <50 copies/mL 95.6% (1700/1779) 96.7% (1312/1356) respectively. rates 99.2% (1765/1779) 99.7% (1352/1356) when considering <200 copies/mL. resistance mutations detected virologic failures. B/F/TAF discontinuations accounted 10.2% (200). Simplification most common reason discontinuation 3.8% (74) patients. Conclusion controlled PLWH, achieved slightly improved individuals aged 60 over switching.

Language: Английский

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Application of CMO (capacity, motivation, and opportunity) methodology in pharmaceutical care to optimize the pharmacotherapy in older people living with HIV. DISPIMDINAC project

Revista Española de Quimioterapia, Journal Year: 2023, Volume and Issue: 36(6), P. 584 - 591

Published: Sept. 19, 2023

Objective. To determine the effectiveness of a pharmaceutical intervention, based on CMO methodology (capacity, motivation and opportunity), to decrease prevalence PIMDINAC concept (potentially inappropriate medication+drug interactions+non-adherence concomitant medication) in people living with HIV infection. Material methods. Longitudinal prospective multicenter study, conducted between October 2021 2022. Patients older than 65 years, antiretroviral treatment drug prescription were included. Demographic, clinical, pharmacotherapeutic variables collected. Pharmaceutical care was provided for6 months according model each patient. The main variable percentage patients who simultaneously fulfilled concept, comparing baseline value same at end study. In addition, patient’s adherent meeting targets established for prescribed medicationat 24 weeks follow-up compared. Results. Sixty-eight Seventy-two percent men, median age 68 years. number drugs 7. A 60.6% had polypharmacy. presence decreased significantly (10.3 vs. 0%). isolation, aspects also (p<0.031). met objectives improved from 48,5 88.2 (p<0.001). Conclusions. intervention onarmaceutical increased achieved objectives, optimising their pharmacotherapy.

Language: Английский

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Efficacy and safety of switching to dolutegravir/lamivudine in virologically suppressed people with HIV-1 aged ≥ 50 years: week 48 pooled results from the TANGO and SALSA studies

AIDS Research and Therapy, Journal Year: 2024, Volume and Issue: 21(1)

Published: March 21, 2024

Abstract Background As the population of people with HIV ages, concerns over managing age-related comorbidities, polypharmacy, immune recovery, and drug-drug interactions while maintaining viral suppression have arisen. We present pooled TANGO SALSA efficacy safety results dichotomized by age (< 50 ≥ years). Methods Week 48 data from open-label phase 3 trials evaluating switch to once-daily dolutegravir/lamivudine (DTG/3TC) fixed-dose combination vs continuing current antiretroviral regimen (CAR) were pooled. Proportions participants HIV-1 RNA < copies/mL (Snapshot, intention-to-treat exposed) analyzed category. Adjusted mean change baseline in CD4 + cell count was assessed using mixed-models repeated-measures analysis. Results Of 1234 participants, 80% whom male, 29% aged years. Among those years, 1/177 1%) DTG/3TC participant 3/187 (2%) CAR had at weeks; proportions high both treatment groups (≥ 92%), consistent overall similar observations years 93%). Regardless category, increased or maintained DTG/3TC. Change /CD8 ratio across between groups. One confirmed virologic withdrawal, but no resistance detected. In group, incidence adverse events (AEs) AEs leading withdrawal low comparable Although drug-related generally low, groups, more frequent who switched compared continued CAR. While few serious observed reported Conclusions individuals HIV-1, switching rates demonstrated a favorable profile, including despite higher prevalence concomitant medication use comorbidities. Trial registration number: TANGO, NCT03446573 (February 27, 2018); SALSA, NCT04021290 (July 16, 2019).

Language: Английский

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Factors associated with antiretroviral treatment adherence among people living with HIV in Guangdong Province, China: a cross sectional analysis

BMC Public Health, Journal Year: 2024, Volume and Issue: 24(1)

Published: May 20, 2024

Abstract Background Understanding factors associated with antiretroviral treatment (ART) adherence is crucial for ART success among people living HIV (PLHIV) in the “test and treat” era. Multiple psychosocial tend to coexist have a syndemic effect on adherence. We aimed explore of multiple PLHIV newly starting Guangdong Province, China. Methods Newly diagnosed from six cities Province were recruited between May 2018 June 2019, then followed up 2019 August 2020. Baseline follow-up data collected questionnaire national surveillance system, which analyzed this study. A Center Adherence Support Evaluation (CASE) index > 10 points was defined as optimal adherence, measured via participants’ self-reported during survey. Multivariable logistic regression used identify Exploratory factor analysis (EFA) multi-order latent variable structural equation modeling (SEM) performed Results total 734 (68.53%) participants finally included study 1071 baseline participants, whom 91.28% (670/734) had Unemployment (aOR = 1.75, 95%CI: 1.01–3.02), no medication reminder 2.28, 1.09–4.74), low self-efficacy 1.27–4.10), social cohesion 1.82, 1.03–3.19), participation 5.65, 1.71–18.63), side effects 0.46, 0.26–0.81) barriers The EFA second-order SEM showed linear relationship (standardized coefficient 0.43, P < 0.001) (syndemic) factor, consisted three beliefs 0.65, 0.001), supportive environment 0.50, negative emotions coefficient=-0.38, 0.01). self-efficacy, environment, explained 42.3%, 25.3%, 14.1% variance respectively. Conclusions About nine out ten However, more efforts should be made address

Language: Английский

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Dual trajectories of antiretroviral therapy adherence and polypharmacy in women with HIV in the United States

AIDS Research and Therapy, Journal Year: 2023, Volume and Issue: 20(1)

Published: May 13, 2023

Abstract Background Polypharmacy, using five or more medications, may increase the risk of nonadherence to prescribed treatment. We aimed identify interrelationship between trajectories adherence antiretroviral therapy (ART) and polypharmacy. Methods included women with HIV (aged ≥ 18) enrolled in Women’s Interagency Study United States from 2014 2019. used group-based trajectory modeling (GBTM) ART polypharmacy dual GBTM Results Overall, 1,538 were eligible (median age 49 years). analysis revealed latent 42% grouped consistently moderate trajectory. identified four 45% categorized low group. Conclusions The joint model did not reveal any trajectories. Future research should consider examining both variables objective measures adherence.

Language: Английский

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Medicine burden experiences of people living with HIV and association with stigma

AIDS Care, Journal Year: 2023, Volume and Issue: 36(2), P. 227 - 237

Published: Oct. 17, 2023

The medicine burden of people living with HIV (PLWH) is unknown. Between 2018 and 2020, participants completed a survey comprising outcome measures for (LMQ-3) stigma experiences (SSCI-8). Participants were HIV+ adults (≥18 years), using antiretrovirals (ARV) or without non-ARV medicines, recruited via two outpatient clinics in southeast England online charities across the UK. Spearman's correlations between levels scores calculated. mostly males (72%, 101/141) mean (SD) age 48.6 (±12.31) years. Total number medicines ranged from 1-20. High was self-reported by 21.3% (30) associated polypharmacy (≥ 5 medicines) (101.52 Vs 85.08,

Language: Английский

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Evaluation of viral suppression and medication-related burden among HIV-infected adults in a secondary care facility

Exploratory Research in Clinical and Social Pharmacy, Journal Year: 2024, Volume and Issue: 15, P. 100473 - 100473

Published: July 4, 2024

People living with HIV/AIDS (PLHIV) are prone to other health issues that may result from the disease or antiretroviral medicines. These persons experience psychosocial aspects of illness, which negatively affect their quality life and overall treatment outcomes. This study assessed medication-related burden virological response adult PLHIV. cross-sectional involved 417 HIV-positive adults who had been on combined therapy for at least a year State Specialist Hospital Gombe. Nigeria. Patient medication was measured using Living Medication Questionnaire version-3 (LMQ-3). Virological suppression viral loads <1000 copies/ml 20 undetectable HIV RNA levels. The LMQ-3 scores were compared participants' characteristics independent t-tests one-way analysis variance (ANOVA). Regression analyses employed identify predictors burden. P value <0.05 95% confidence interval considered statistically significant. Of PLHIV included in this study, 271 (65%) classified as WHO Stage 1 ART initiation, 93.8% achieved 291 (69.5%) whom females. majority patients 382 (91.6%) dolutegravir-based regimen, no tuberculosis diagnosis (ART) initiation (82.5%) 6–10 years (46.3%). Only 67.6% population moderate Female sex (p < 0.0005), unsuppressed load = 0.01), second-line 0.03), 0.02), employment 0.003) significantly associated predictor high degree (AOR, 0.12; CI, 0.02–0.59) while 0.01) female gender 0.002) related findings revealed Targeted interventions should be directed toward younger patients, females loads.

Language: Английский

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An overview of multimorbidity and polypharmacy in older people living with HIV

Geriatrics and gerontology international/Geriatrics & gerontology international, Journal Year: 2023, Volume and Issue: 24(S1), P. 49 - 59

Published: Nov. 8, 2023

The availability of effective antiretroviral therapy (ART) has revolutionized the care people living with HIV (PLHIV). As a result, PLHIV now have life expectancy comparable that general population. are increasingly confronted age‐related comorbidities and geriatric syndromes, including frailty polypharmacy, which occur at higher prevalence set in an earlier age compared their uninfected counterparts. underlying pathophysiology for multimorbidity polypharmacy multifactorial, multidimensional complex. Therefore, regular review optimization risk factors to maintain physical function, social psychological health is utmost importance. With ever‐growing population older PLHIV, there pressing need provide holistic address these emerging issues. Accelerated aging observed suggests early involvement multidisciplinary team, geriatricians, implementation integrated models can potentially improve who increased complex multimorbidity. This article reviews current global situation, discusses challenges involved approaches deliver comprehensive PLHIV. Geriatr Gerontol Int 2024; 24: 49–59 .

Language: Английский

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