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Antiretroviral therapy adherence and drug-drug interactions in the aging HIV population.

Abstract
It is estimated that by 2015 more than half of all HIV-infected individuals in the United States will be 50 years of age or older. As this population ages, the frequency of non-AIDS related comorbidities increases, which includes cardiovascular, metabolic, gastrointestinal, genitourinary and psychiatric disorders. As a result, medical management of the aging HIV population can be complicated by polypharmacy and higher pill burden, leading to poorer antiretroviral therapy (ART) adherence. Adherence to ART is generally better in older populations when compared to younger populations; however, cognitive impairment in elderly patients can impair adherence, leading to worse treatment outcomes. Practical monitoring tools can improve adherence and increase rates of viral load suppression. Several antiretroviral drugs exhibit inhibitory and/or inducing effects on cytochrome P450 isoenzymes, which are responsible for the metabolism of many medications used for the treatment of comorbidities in the aging HIV population. The combination of ART with polypharmacy significantly increases the chance of potentially serious drug-drug interactions (DDIs), which can lead to drug toxicity, poorer ART adherence, loss of efficacy of the coadministered medication, or virologic breakthrough. Increasing clinicians awareness of common DDIs and the use of DDI programs can prevent coadministration of potentially harmful combinations in elderly HIV-infected individuals. Well designed ART adherence interventions and DDI studies are needed in the elderly HIV population.
AuthorsJean B Nachega, Alice J Hsu, Olalekan A Uthman, Anne Spinewine, Paul A Pham
JournalAIDS (London, England) (AIDS) Vol. 26 Suppl 1 Pg. S39-53 (Jul 31 2012) ISSN: 1473-5571 [Electronic] England
PMID22781176 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-HIV Agents
  • Anticoagulants
  • Cardiovascular Agents
Topics
  • Acquired Immunodeficiency Syndrome (drug therapy, epidemiology)
  • Aged
  • Aged, 80 and over
  • Aging
  • Anti-HIV Agents (administration & dosage, adverse effects, pharmacology)
  • Anticoagulants (administration & dosage, adverse effects, pharmacology)
  • CD4 Lymphocyte Count
  • Cardiovascular Agents (administration & dosage, adverse effects, pharmacology)
  • Comorbidity
  • Drug Interactions
  • Female
  • Humans
  • Life Expectancy
  • Male
  • Medication Adherence
  • Middle Aged
  • Polypharmacy
  • Population Surveillance
  • United States (epidemiology)
  • Viral Load

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