Análisis de la complejidad farmacoterapéutica y la necesidad potencial de desprescripción en pacientes con infección por el VIH

Laburpena

Introduction: Improvements in antiretroviral treatment (ART) have transform HIV infection into a chronic disease with an expected lifespan close to or the same as those for the uninfected population. People living with HIV (PLWH), moreover, experience a chronic inflammation state that results in premature aging and the appearance of age-related conditions earlier than in the general population. This has led to a change in the profile of this population, older and with a high pharmacotherapeutic complexity, which increases the risk of drug-related problems that must be addressed, and which we must previously identify. Objective To assess the prevalence of aging and to determine the profile of comorbidities, the prevalence of multipathology and the pharmacotherapeutic complexity in PLWH attended in the Pharmaceutical Care Consultation of the reference hospital of a health area. To analyze the need for optimization and/or deprescription of non-ART therapy and to identify the factors associated with presenting drugs susceptible to intervention in chronic treatment. Patients and methods Transversal descriptive study, developed in two phases. In the first phase, a multidisciplinary group was formed for the preparation of a list of drugs susceptible to a posible deprescription for the optimization of chronic therapy in our population from the tools published in the literature. In the second phase, a clinical interview was conducted to obtain the complete pharmacotherapeutic history and the comorbidity profile. The SMAQ and PATD questionnaires were administered to determine the adherence and their feelings about stopping any of their prescribed drugs, respectively. Based on the data obtained, a complete review of the pharmacotherapy and the patient&apos;s clinical situation was carried out with the objective of identifying the drugs that would be considered candidates for a future deprescription, based on the criteria of the tool developed in the first phase of this study. Results We included 210 patients (76.7% males, with a median age of 51 years [RIQ: 42-56]), 57.6% of them were over 50 years old and 48.6% of the population was between 50 and 65 years old. The median of comorbidities was 2 per patient (RIQ: 1-4) and 60% were pluripathologic (?2 chronic pathologies). The most prevalent comorbidities were vitamin D deficiency (27.6%), dyslipidemia (26.2%) and mood-related disorders (24.3%). 45.7% of patients were polymedicated (?6 concomitant drugs) and 12.4% had "higher polypharmacy" (?11 drugs), with a median of 5 drugs (RIQ: 3-8) per patient. The median of complexity index was 9 (RIQ: 5.5 - 16.7) and 43.8% had a score ?11. The most prescribed therapeutic groups were vitamin D and analogs (31.4%), benzodiazepines (26.2%) and proton pump inhibitors (PPI) (22.9%). Both pluripathology and polypharmacy were significantly associated with increasing age (p <0.01). We identified drugs susceptible to deprescription in 41.4% of patients. The most involved therapeutic groups were benzodiazepines and PPIs. In the multivariate analysis, the risk factors associated with presenting at least one drug susceptible to intervention were polypharmacy (OR: 7.26 [95% CI: 3.58-14.70]), mood-related disorders (OR: 5.76 [IC95%: 2.31-13.81]) and musculoskeletal diseases (OR: 3.40 [95% CI: 1.04-11.05]). According to the PATD questionnaire, 72.4% of patients would like to reduce the number of medications that they were currently taking, and 62.9% would agree that the pharmacist withdraw one or more of their medications informing the doctor of their evolution. Conclusions Our results demonstrate that PLWH of our health area is aging and presents a high burden of both morbidity and polypharmacy, mainly at the expense of non-antiretroviral therapy. In addition, the high number of drugs identified as candidates for deprescription or optimization and their relationship to polypharmacy reinforce the need for coordinated intervention in this population.