Management of HIV/AIDS in older patients-drug/drug interactions and adherence to antiretroviral therapy

Mary J Burgess, John D Zeuli, Mary J Kasten, Mary J Burgess, John D Zeuli, Mary J Kasten

Abstract

Patients with human immunodeficiency virus (HIV) are living longer with their disease, as HIV has become a chronic illness managed with combination antiretroviral therapy (cART). This has led to an increasing number of patients greater than 50 years old living successfully with HIV. As the number of older adults with HIV has increased, there are special considerations for the management of HIV. Older adults with HIV must be monitored for drug side effects and toxicities. Their other non-HIV comorbidities should also be considered when choosing a cART regimen. Older adults with HIV have unique issues related to medication compliance. They are more likely than the younger HIV patients to have vision loss, cognitive impairment, and polypharmacy. They may have lower expectations of their overall health status. Depression and financial concerns, especially if they are on a fixed income, may also contribute to noncompliance in the aging HIV population.

Keywords: HIV; aging population; drug interactions; management issues; medication adherence.

References

    1. Work Group for HIV Aging Consensus Project Summary report from the Human Immunodeficiency Virus and Aging Consensus Project: treatment strategies for clinicians managing older individuals with the human immunodeficiency virus. J Am Geriatr Soc. 2012;60(5):974–979.
    1. Guaraldi G, Orlando G, Zona S, et al. Premature age-related comorbidi-ties among HIV-infected persons compared with the general population. Clin Infect Dis. 2011;53(11):1120–1126.
    1. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1–17. quiz CE11-14.
    1. Moyer VA. Screening for HIV: US Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2013;159(1):51–60.
    1. Adekeye OA, Heiman HJ, Onyeabor OS, Hyacinth HI. The new invincibles: HIV screening among older adults in the US. PLoS One. 2012;7(8):e43618.
    1. Skiest DJ, Keiser P. Human immunodeficiency virus infection in patients older than 50 years. A survey of primary care physicians’ beliefs, prac-tices, and knowledge. Arch Fam Med. 1997;6(3):289–294.
    1. Prejean J, Song R, Hernandez A, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS One. 2011;6(8):e17502.
    1. Althoff KN, Gebo KA, Gange SJ, et al. CD4 count at presentation for HIV care in the United States and Canada: are those over 50 years more likely to have a delayed presentation? AIDS Res Ther. 2010;7:45.
    1. Centers for Disease Control and Prevention (CDC) Vital signs: HIV prevention through care and treatment – United States. MMWR Morb Mortal Wkly Rep. 2011;60(47):1618–1623.
    1. Linley L, Prejean J, An Q, Chen M, Hall HI. Racial/ethnic disparities in HIV diagnoses among persons aged 50 years and older in 37 US States, 2005–2008. Am J Public Health. 2012;102(8):1527–1534.
    1. Greene M, Justice AC, Lampiris HW, Valcour V. Management of human immunodeficiency virus infection in advanced age. JAMA. 2013;309(13):1397–1405.
    1. Panel on Antiretroviral Guidelines for Adults and Adolescents . Initiating antiretroviral therapy in treatment-naive patients Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Department of Health and Human Services; [Accessed May 26, 2015]. Available from: . Section accessed. What to start: Initial combination regimens for the antiretroviral naive patient.
    1. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. ; Jul 20, pp. 1–13. 2915.
    1. Sabin CA, Smith CJ, d’Arminio Monforte A, et al. Response to combination antiretroviral therapy: variation by age. AIDS. 2008;22(12):1463–1473.
    1. Althoff KN, Justice AC, Gange SJ, et al. Virologic and immunologic response to HAART, by age and regimen class. AIDS. 2010;24(16):2469–2479.
    1. Khanna N, Opravil M, Furrer H, et al. CD4+ T cell count recovery in HIV type 1-infected patients is independent of class of antiretroviral therapy. Clin Infect Dis. 2008;47(8):1093–1101.
    1. Mellors JW, Rinaldo CR, Jr, Gupta P, White RM, Todd JA, Kingsley LA. Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science. 1996;272(5265):1167–1170.
    1. Reekie J, Gatell JM, Yust I, et al. Fatal and nonfatal AIDS and non-AIDS events in HIV-1-positive individuals with high CD4 cell counts according to viral load strata. AIDS. 2011;25(18):2259–2268.
    1. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
    1. Sankar A, Nevedal A, Neufeld S, Berry R, Luborsky M. What do we know about older adults and HIV? A review of social and behavioral literature. AIDS Care. 2011;23(10):1187–1207.
    1. Stall R, Catania J. AIDS risk behaviors among late middle-aged and elderly Americans. The National AIDS Behavioral Surveys. Arch Intern Med. 1994;154(1):57–63.
    1. Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357(8):762–774.
    1. Little SJ, Holte S, Routy JP, et al. Antiretroviral-drug resistance among patients recently infected with HIV. N Engl J Med. 2002;347(6):385–394.
    1. Kuritzkes DR, Lalama CM, Ribaudo HJ, et al. Preexisting resistance to nonnucleoside reverse-transcriptase inhibitors predicts virologic failure of an efavirenz-based regimen in treatment-naive HIV-1-infected subjects. J Infect Dis. 2008;197(6):867–870.
    1. Devereux HL, Youle M, Johnson MA, Loveday C. Rapid decline in detectability of HIV-1 drug resistance mutations after stopping therapy. AIDS. 1999;13(18):F123–F127.
    1. Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc. 1985;33(4):278–285.
    1. Schmucker DL. Liver function and phase I drug metabolism in the elderly: a paradox. Drugs Aging. 2001;18(11):837–851.
    1. Knobel H, Guelar A, Valldecillo G, et al. Response to highly active antiretroviral therapy in HIV-infected patients aged 60 years or older after 24 months follow-up. AIDS. 2001;15(12):1591–1593.
    1. Wellons MF, Sanders L, Edwards LJ, Bartlett JA, Heald AE, Schmader KE. HIV infection: treatment outcomes in older and younger adults. J Am Geriatr Soc. 2002;50(4):603–607.
    1. Feely J, Coakley D. Altered pharmacodynamics in the elderly. Clin Geriatr Med. 1990;6(2):269–283.
    1. . [homepage on the Internet]
    1. Samoy LJ, Zed PJ, Wilbur K, Balen RM, Abu-Laban RB, Roberts M. Drug-related hospitalizations in a tertiary care internal medicine service of a Canadian hospital: a prospective study. Pharmacotherapy. 2006;26(11):1578–1586.
    1. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9):1107–1116.
    1. Gurwitz JH, Field TS, Judge J, et al. The incidence of adverse drug events in two large academic long-term care facilities. Am J Med. 2005;118(3):251–258.
    1. Deeks ED. Cobicistat: a review of its use as a pharmacokinetic enhancer of atazanavir and darunavir in patients with HIV-1 infection. Drugs. 74(2):195–206.
    1. American Geriatrics Society 2012 Beers Criteria Update Expert Panel American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–631.
    1. Yoganathan K, David L, Williams C, Jones K. Cushing’s syndrome with adrenal suppression induced by inhaled budesonide due to a ritonavir drug interaction in a woman with HIV infection. Int J STD AIDS. 2012;23(7):520–521.
    1. Valin N, De Castro N, Garrait V, Bergeron A, Bouche C, Molina JM. Iatrogenic Cushing’s syndrome in HIV-infected patients receiving rito-navir and inhaled fluticasone: description of 4 new cases and review of the literature. J Int Assoc Physicians AIDS Care (Chicago) 2009;8(2):113–121.
    1. Kharasch ED, Bedynek PS, Walker A, Whittington D, Hoffer C. Mechanism of ritonavir changes in methadone pharmacokinetics and pharmacodynamics: II. Ritonavir effects on CYP3A and P-glycoprotein activities. Clin Pharmacol Ther. 2008;84(4):506–512.
    1. Bruce RD, Winkle P, Custodio J, et al. Pharmacokinetics of cobicistat-boosted elvitegravir administered in combination with methadone or buprenorphine/naloxone; 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy; September 9–12 2012; San Francisco, CA. ICAAC 2012.
    1. Liu H, He X, Levy JA, Xu Y, Zang C, Lin X. Psychological impacts among older and younger people living with HIV/AIDS in Nanning, China. J Aging Res. 2014;2014:576592.
    1. Stein JH. Cardiovascular risk and dyslipidemia management in HIV-infected patients. Top Antivir Med. 2012;20(4):129–133. quiz 123–124.
    1. Wohl DA, Arnoczy G, Fichtenbaum CJ, et al. Comparison of cardiovascular disease risk markers in HIV-infected patients receiving abacavir and tenofovir: the nucleoside inflammation, coagulation and endothelial function (NICE) study. Antivir Ther. 2014;19(2):141–147.
    1. Ding X, Andraca-Carrera E, Cooper C, et al. No association of abacavir use with myocardial infarction: findings of an FDA meta-analysis. J Acquir Immune Defic Syndr. 2012;61(4):441–447.
    1. El-Sadr WM, Lundgren J, Neaton JD, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355(22):2283–2296.
    1. Aberg JA, Kaplan JE, Libman H, et al. Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(5):651–681.
    1. Onen NF, Overton ET, Seyfried W, et al. Aging and HIV infection: a comparison between older HIV-infected persons and the general population. HIV Clin Trials. 2010;11(2):100–109.
    1. Walker Harris V, Brown TT. Bone loss in the HIV-infected patient: evidence, clinical implications, and treatment strategies. J Infect Dis. 2012;205(Suppl 3):S391–S398.
    1. de Silva TI, Post FA, Griffin MD, Dockrell DH. HIV-1 infection and the kidney: an evolving challenge in HIV medicine. Mayo Clin Proceed. 2007;82(9):1103–1116.
    1. Kalayjian RC, Lau B, Mechekano RN, et al. Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care. AIDS. 2012;26(15):1907–1915.
    1. Deeken JF, Tjen ALA, Rudek MA, et al. The rising challenge of non-AIDS-defining cancers in HIV-infected patients. Clin Infect Dis. 2012;55(9):1228–1235.
    1. Price JC, Thio CL. Liver disease in the HIV-infected individual. Clin Gastroenterol Hepatol. 2010;8(12):1002–1012.
    1. Mindikoglu AL, Regev A, Magder LS. Impact of human immunodeficiency virus on survival after liver transplantation: analysis of United Network for Organ Sharing database. Transplantation. 2008;85(3):359–368.
    1. Silverberg MJ, Leyden W, Horberg MA, DeLorenze GN, Klein D, Quesenberry CP., Jr Older age and the response to and tolerability of antiretroviral therapy. Arch Intern Med. 2007;167(7):684–691.
    1. Wutoh AK, Brown CM, Kumoji EK, et al. Antiretroviral adherence and use of alternative therapies among older HIV-infected adults. J Natl Med Assoc. 2001;93(7–8):243–250.
    1. Wutoh AK, Elekwachi O, Clarke-Tasker V, Daftary M, Powell NJ, Campusano G. Assessment and predictors of antiretroviral adherence in older HIV-infected patients. J Acquir Immune Defic Syndr. 2003;33(Suppl 2):S106–S114.
    1. Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother. 2011;9(1):11–23.
    1. van Eijken M, Tsang S, Wensing M, de Smet PA, Grol RP. Interventions to improve medication compliance in older patients living in the community: a systematic review of the literature. Drugs Aging. 2003;20(3):229–240.
    1. Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998;36(8):1138–1161.
    1. [webpage on the Internet] [Accessed February 11, 2014]. Available from: .
    1. [webpage on the Internet] [Accessed February 11, 2014]. Available from: .

Source: PubMed

3
Subskrybuj