1. AIDS. 2012 Jul 31;26 Suppl 1:S39-53.

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

Nachega JB, Hsu AJ, Uthman OA, Spinewine A, Pham PA.

Department of International Health, Johns Hopkins Bloomberg School of Public
Health, Baltimore, Maryland 21205, USA. jnachega@jhsph.edu

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.

PMID: 22781176  [PubMed - in process]