Módulo 1 – Curso pós-graduado – VIH e Envelhecimento

Drug-drug Interactions and Polypharmacy in Older HIV Persons

Drug interactions and management of HIV infection

Autor: David Burger, PharmD PhD (Radboud University Nijmegen, Holanda)

HIV, Aging and Polypharmacy

Data from Athena Study were recently published, a study that aimed to evaluate the effect of aging on HIV population.1

Based on the results from this cohort, it is expected that the proportion of patients aged >= 50 years and receiving antiretroviral treatment increases from 28% to 73% between 2010 and 2030. This trend will result in the increase of other comorbidities, particularly cardiovascular disease, diabetes and cancer (whether or not related to HIV infection).2

In the study by Marzolini et al. it was observed that approximately 40% of patients <50 years were not co-medicated (in addi- tion to HIV treatment) versus 20% in patients aged >= 50 years.3 Moreover, Holtzman et al. found that individuals polymedicated with five or more drugs – i.e., two more drugs in addition to antiretroviral treatment (usually three drugs) – have a higher risk of toxicity.4 With the increased prevalence of cardiovascular disease in this population it is also expected an increased use of cardiovascular medications.

In addition, pharmacokinetic data for the age group between 50 and 60 years suggest that there are no differences even in the presence of a larger number of comorbidities. It is possible that changes with impact on the pharmacokinetics will be more significant in older ages (from 70 – 80 years). Hence, if there is a suspicion of toxicity in a patient aged 75 years, therapeutic drug monitoring (TDM) of antiretroviral drugs may be advisable, to confirm that concen- trations are above the safety margin. This is particularly relevant in HIV treatment, where it is not possible to gradually increase the dosage due to the risk of resistance. Besides this situation, TDM can be useful to evaluate interactions that result in changes of the antiretrovirals concentration.

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