Prescribing issues among older HIV-infected persons in a Mediterranean
cohort: Does the current prevalence give cause for concern?
AIM: The main objective was to determine the prevalence of prescribing
issues in HIV-infected subjects ≥65 years according to the Beers and
STOPP/START criteria and drug-drug interactions (Liverpool website).
Secondary objectives were to assess the concordance between Beers and
STOPP/START criteria in our population, and to identify the drugs most
frequently involved in the prescribing issues. METHODS: Cross-sectional
cohort study based on a systematic review of the electronic drug
prescriptions of 91 HIV-infected patients aged ≥65 years. Discrepancies
between prescription criteria were assessed using crosstabs and compared
using the Chi-square test or Fisher exact test. RESULTS: The mean age
was 72.1 (5.6) years, 75.8% had ≥3 comorbidities, and 59.3%
polypharmacy. Prescribing issues were identified in 87.9%; 71.4% by
STOPP/START and 45.1% by Beers. Comparing both criteria, 56.9% of
prescribing issues by STOPP/START were detected by Beers, while 92.5%
of those detected by the Beers criteria were detected by STOPP/START
(p<0.001). Orange/red flag interactions were found in 45.1%:
3 severe (red) in 2 patients (2.2%). The most frequent drugs involved
in prescribing issues were benzodiazepines (>30%).
Cobicistat was the drug most frequently involved in interactions
(42.9%). CONCLUSIONS: The prevalence of prescribing issues among older
HIV-infected persons gives cause for concern, as it is almost 90%.
Optimization strategies, including a critical review of the treatment
plan, should be implemented in clinical routine by a multidisciplinary
team, in particular in patients with multiple comorbidities and
polypharmacy. The STOPP/START criteria should be recommended for
European populations, since they seem to better detect prescribing