scholarly journals Analysis of inappropriate prescribing in elderly patients of the Swiss HIV Cohort Study reveals gender inequity

2020 ◽  
Author(s):  
Françoise Livio ◽  
Elisabeth Deutschmann ◽  
Giusi Moffa ◽  
Flamur Rrustemi ◽  
Felix Stader ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Geriatric Medicine ◽  
Inappropriate Prescribing ◽  
Median Number ◽  
People Living With Hiv ◽  
Periodic Review ◽  
Start Criteria ◽  
Hiv Women ◽  
Hiv Drugs

Abstract Background The extent of inappropriate prescribing observed in geriatric medicine has not been thoroughly evaluated in people ageing with HIV. We determined the prevalence of and risk factors for inappropriate prescribing in individuals aged ≥75 years enrolled in the Swiss HIV Cohort Study. Methods Retrospective review of medical records was performed to gain more insights into non-HIV comorbidities. Inappropriate prescribing was screened using the Beers criteria, the STOPP/START criteria and the Liverpool drug–drug interactions (DDIs) database. Results For 175 included individuals, the median age was 78 years (IQR 76–81) and 71% were male. The median number of non-HIV comorbidities was 7 (IQR 5–10). The prevalence of polypharmacy and inappropriate prescribing was 66% and 67%, respectively. Overall, 40% of prescribing issues could have deleterious consequences. Prescribing issues occurred mainly with non-HIV drugs and included: incorrect dosage (26%); lack of indication (21%); prescription omission (drug not prescribed although indicated) (17%); drug not appropriate in elderly individuals (18%) and deleterious DDIs (17%). In the multivariable logistic regression, risk factors for prescribing issues were polypharmacy (OR: 2.5; 95% CI: 1.3–4.7), renal impairment (OR: 2.7; 95% CI: 1.4–5.1), treatment with CNS-active drugs (OR: 2.1; 95% CI: 1.1–3.8) and female sex (OR: 8.3; 95% CI: 2.4–28.1). Conclusions Polypharmacy and inappropriate prescribing are highly prevalent in elderly people living with HIV. Women are at higher risk than men, partly explained by sex differences in the occurrence of non-HIV comorbidities and medical care. Medication reconciliation and periodic review of prescriptions by experienced physicians could help reduce polypharmacy and inappropriate prescribing in this vulnerable, growing population.

scholarly journals 925. Adverse Events Due to Inappropriate Prescribing in Older Adults Living with HIV

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S496-S496
Author(s):  
Mark Cinquegrani ◽  
M Gabriela Cabanilla ◽  
Keenan L Ryan ◽  
Catia Marzolini ◽  
Bernadette Jakeman
Keyword(s):  
Adverse Events ◽  
Drug Interactions ◽  
Inappropriate Prescribing ◽  
Panel Member ◽  
People Living With Hiv ◽  
Start Criteria ◽  
Age Related ◽  
Hiv Drugs ◽  
The University ◽  
Living With Hiv

Abstract Background People living with HIV (PLWH) are aging and experience age-related comorbidities as well as physiological changes leading to a higher risk for polypharmacy, drug-drug interactions, inappropriate prescribing and related adverse events (AE). Prior studies have highlighted a growing concern for inappropriate prescribing in older PLWH. The objective of this study was to examine the prevalence of AEs resulting from inappropriate prescribing in PLWH > 65 years of age. Methods This was a retrospective chart review. PLWH followed-up at the outpatient HIV clinic at the University Hospital in New Mexico between 01/01/2015 and 08/21/ 2018 were eligible if they were > 65 years of age and had >1 potentially inappropriate prescriptions (PIP). PIP were identified using the Beers and STOPP/START criteria for inappropriate mediations in elderly, as well as drugs incorrectly dosed, and potentially deleterious drug-drug interactions (DDI). The University of Liverpool’s HIV interaction checker and Lexicomp’s interaction checker were used to screen for DDI between HIV and non-HIV drugs, and between non-HIV drugs. AEs related to PIPs were collected and their severity was classified using the WHO scale for grading of AEs. Results A total of 104 PLWH >65 years of age fulfilled the eligibility criteria. Most patients were male (88.5%) with an average age of 69 years. The majority of patients were virologically suppressed (89%), with an average CD4 cell count of 650 cells/µL. Polypharmacy (>5 non-HIV medications) was identified in all 104 patients; average number of non-HIV medications was 9.4 + 4.8. 30 (28.8%) patients experienced >1 AE, with a total of 53 AEs identified. Of those, 20 (67%) presented with a serious AE. 14 patients (47%) had to seek treatment at an emergency department and 2 patients (7%) had to be hospitalized. The most common AEs included falls (27/53 events; 51%), bleeds (7/53 events; 13%), fractures (4/53 events; 8%). Risk for an AE was significantly associated with increasing number of medications (OR 1.16; 95% CI 1.05-1.29). Conclusion PIP and related AEs are common in older PLWH. Interventions to prevent harm including medication reconciliation, medication review, and medication prioritization according to the risks/benefits of individual patients are warranted. Disclosures Keenan L. Ryan, PharmD, PhC, Theravance (Advisor or Review Panel member)

scholarly journals Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – A retrospective cohort study

2016 ◽  
Vol 28 (5) ◽  
pp. 480-485 ◽  
Author(s):  
J Hiesgen ◽  
C Schutte ◽  
S Olorunju ◽  
J Retief
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Mortality Risk ◽  
Retrospective Cohort Study ◽  
Cryptococcal Meningitis ◽  
Retrospective Cohort ◽  
Nausea And Vomiting ◽  
People Living With Hiv

Aim This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with cryptococcal meningitis. These factors include the patient’s socio-economic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy. Methods Data were collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed cryptococcal meningitis over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients’ mortality risk. Results A total of 87 patients were identified. All except one were HIV-positive, of which 55.2% were antiretroviral therapy naïve. A history of previous tuberculosis was given by 25 patients (28.7%) and 49 (56.3%) were on tuberculosis treatment at admission or started during their hospital stay. In-hospital mortality was 31%. Statistical analysis showed that antiretroviral therapy naïve patients had 9.9 (CI 95% 1.2–81.2, p < 0.0032) times greater odds of dying compared to those on antiretroviral therapy, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment. Defaulters had 14.7 (CI 95% 1.6–131.6, p < 0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7–23.1, p < 0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for antiretroviral therapy naïve patients and defaulters. Conclusion Cryptococcal meningitis is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting antiretroviral therapy and presentation with nausea and vomiting were associated with a significantly increased mortality risk.

scholarly journals Factors associated to potentially inappropriate prescribing in older patients according to STOPP/START criteria: MoPIM multicentre cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Marisa Baré ◽  
Marina Lleal ◽  
Sara Ortonobes ◽  
Maria Queralt Gorgas ◽  
Daniel Sevilla-Sánchez ◽  
...  
Keyword(s):  
Cohort Study ◽  
Chronic Disease ◽  
Medication Review ◽  
Older Patients ◽  
Primary Outcome ◽  
Inappropriate Prescribing ◽  
Potentially Inappropriate Prescribing ◽  
Disease Exacerbation ◽  
Factors Associated ◽  
Start Criteria

Abstract Objectives The objectives of the present analyses are to estimate the frequency of potentially inappropriate prescribing (PIP) at admission according to STOPP/START criteria version 2 in older patients hospitalised due to chronic disease exacerbation as well as to identify risk factors associated to the most frequent active principles as potentially inappropriate medications (PIMs). Methods A multicentre, prospective cohort study including older patients (≥65) hospitalized due to chronic disease exacerbation at the internal medicine or geriatric services of 5 hospitals in Spain between September 2016 and December 2018 was conducted. Demographic and clinical data was collected, and a medication review process using STOPP/START criteria version 2 was performed, considering both PIMs and potential prescribing omissions (PPOs). Primary outcome was defined as the presence of any most frequent principles as PIMs, and secondary outcomes were the frequency of any PIM and PPO. Descriptive and bivariate analyses were conducted on all outcomes and multilevel logistic regression analysis, stratified by participating centre, was performed on the primary outcome. Results A total of 740 patients were included (mean age 84.1, 53.2% females), 93.8% of them presenting polypharmacy, with a median of 10 chronic prescriptions. Among all, 603 (81.5%) patients presented at least one PIP, 542 (73.2%) any PIM and 263 (35.5%) any PPO. Drugs prescribed without an evidence-based clinical indication were the most frequent PIM (33.8% of patients); vitamin D supplement in older people who are housebound or experiencing falls or with osteopenia was the most frequent PPO (10.3%). The most frequent active principles as PIMs were proton pump inhibitors (PPIs) and benzodiazepines (BZDs), present in 345 (46.6%) patients. This outcome was found significantly associated with age, polypharmacy and essential tremor in an explanatory model with 71% AUC. Conclusions PIMs at admission are highly prevalent in these patients, especially those involving PPIs or BZDs, which affected almost half of the patients. Therefore, these drugs may be considered as the starting point for medication review and deprescription. Trial registration number NCT02830425

scholarly journals Incidence of non-communicable diseases (NCDs) in HIV patients on ART in a developing country: Case of Zimbabwe’s Chitungwiza Central Hospital—A retrospective cohort study (2010–2019)

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252180
Author(s):  
Alexander Cheza ◽  
Boikhutso Tlou ◽  
Danai Tavonga Zhou
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Communicable Diseases ◽  
People Living With Hiv ◽  
Central Hospital ◽  
Hiv Patients ◽  
Non Communicable Diseases

Introduction The incidence of non-communicable diseases (NCDs) has been reported to be rising over the years leading up to 2010. In Zimbabwe, there are few studies done to examine the incidence of NCDs in people living with HIV (PLHIV) on anti-retroviral treatment (ART). Objective To determine the incidence of NCDs in HIV patients on ART at the Chitungwiza Central Hospital over ten years and the associated risk factors. Methods This was a retrospective cohort study using data from 203 patients enrolled on ART at the Chitungwiza Central Hospital between 2010 and 2019. All 500 records were considered and the selection was based on participants’ consenting to the study and their strict adherence to ART without absconding. The incidence of NCDs was determined and generalized estimating equations (GEE) were used to estimate the association between NCDs and the selected risk factors. Findings Data collected at the study’s baseline (2010) showed that the most prevalent NCD was hypertension, found in (18/203) 8.9% of the study participants, followed by diabetes (6.9%), then followed by cardiovascular diseases (CVD) (3.9%), and the least common NCD was cancer (1.9%). Incidences of all of these NCDs showed an increasing trend as the time of follow-up progressed. The factors found to be significantly associated with the development of NCDs were gender (p = 0.002) and follow-up time (p<0.001). Geographical location was a significant risk factor as urban patients were more likely to develop hypertension as compared to the peri-urban patients (p = 0.001). Conclusions NCDs and HIV comorbidity is common with women more likely than males to develop NCDs as they advance in age. There is need to devise targeted intervention approach to the respective NCDs and risk factors since they affect differently in relation to the demographic details of the participants. Recommendations This paper recommends a multi-stakeholder approach to the management of NCDs, with researchers, clinicians and the government and its various arms taking a leading role.

scholarly journals Treatment outcomes in HIV infected patients older than 50 years attending an HIV clinic in Harare, Zimbabwe: A cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253000
Author(s):  
Tinei Shamu ◽  
Cleophas Chimbetete ◽  
Matthias Egger ◽  
Tinashe Mudzviti
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Significant Proportion ◽  
Cox Proportional Hazards ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Viral Loads ◽  
Cell Counts

There is a growing number of older people living with HIV (OPLHIV). While a significant proportion of this population are adults growing into old age with HIV, there are also new infections among OPLHIV. There is a lack of data describing the outcomes of OPLHIV who commenced antiretroviral therapy (ART) after the age of 50 years in sub-Saharan Africa. We conducted a cohort study of patients who enrolled in care at Newlands Clinic in Harare, Zimbabwe, at ages ≥50 years between February 2004 and March 2020. We examined demographic characteristics, attrition, viral suppression, immunological and clinical outcomes. Specifically, we described prevalent and incident HIV-related communicable and non-communicable comorbidities. We calculated frequencies, medians, interquartile ranges (IQR), and proportions; and used Cox proportional hazards models to identify risk factors associated with death. We included 420 (57% female) who commenced ART and were followed up for a median of 5.6 years (IQR 2.4–9.9). Most of the men were married (n = 152/179, 85%) whereas women were mostly widowed (n = 125/241, 51.9%). Forty per cent (n = 167) had WHO stage 3 or 4 conditions at ART baseline. Hypertension prevalence was 15% (n = 61) at baseline, and a further 27% (n = 112) had incident hypertension during follow-up. During follow-up, 300 (71%) were retained in care, 88 (21%) died, 17 (4%) were lost to follow-up, and 15 (4%) were transferred out. Of those in care, 283 (94%) had viral loads <50 copies/ml, and 10 had viral loads >1000 copies/ml. Seven patients (1.7%) were switched to second line ART during follow-up and none were switched to third-line. Higher baseline CD4 T-cell counts were protective against mortality (p = 0.001) while male sex (aHR: 2.29, 95%CI: 1.21–4.33), being unmarried (aHR: 2.06, 95%CI: 1.13–3.78), and being unemployed (aHR: 2.01, 95%CI: 1.2–3.37) were independent independent risk factors of mortality. There was high retention in care and virologic suppression in this cohort of OPLHIV. Hypertension was a common comorbidity. Being unmarried or unemployed were significant predictors of mortality highlighting the importance of sociologic factors among OPLHIV, while better immune competence at ART commencement was protective against mortality.

scholarly journals Prevalence and Risk Factors of Active TB among Adult HIV Patients Receiving ART in Northwestern Tanzania: A Retrospective Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Daniel W. Gunda ◽  
Simon C. Maganga ◽  
Igembe Nkandala ◽  
Semvua B. Kilonzo ◽  
Bonaventura C. Mpondo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Stage ◽  
Male Gender ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Hiv Patients ◽  
Northwestern Tanzania

Introduction. Although ART has improved the outcome of people living with HIV/AIDS, still some patients develop TB while receiving ART. The literature on the magnitude of this problem is still scarce in our setting especially northwestern Tanzania. This study was designed to determine the prevalence of active TB among HIV patients on ART and assess its potential risk factors.Methods. A retrospective cohort study was done among adult HIV-positive patients initiated on ART at Bugando Medical Centre. Patients who were TB positive before ART initiation were excluded. Data regarding demographic, clinical, and laboratory information, TB status on receipt of ART, and time on ART were collected and analyzed using STATA 11 to determine the prevalence of TB and its associated factors.Results. In total, 391 patients were enrolled in this study. The median age was 39 (32–46) years, and a total of 129 (32.99%) participants had CD4 counts <200 cells/µl and 179 (45.78%) had WHO stage 3 and 4 illnesses. A total of 43 (11.0%) participants developed TB while receiving ART which was independently associated with male gender (OR = 2.9;p=0.007), WHO clinical stage 3 and 4 (OR = 1.4;p=0.029), baseline CD4 count <200 cells/µl (OR = 9.1;p<0.001), and having not used IPT (OR = 3.1;p=0.05).Conclusions. Active TB is prevalent among HIV patients while receiving ART in northwestern Tanzania which is independently associated with male gender, advanced HIV disease, and nonuse of IPT. Universal HIV testing could reduce late HIV diagnosis and hence reduce the risk of developing TB while receiving ART in our setting. Also IPT should be widely used for those who are negative for TB on screening.

scholarly journals Efficacy of metronidazole to prevent active pulmonary tuberculosis in people living with HIV/AIDS on highly active anti-retroviral therapy: a prospective cohort study

2020 ◽  
Vol 8 (11) ◽  
pp. 3826
Author(s):  
Ketut Suryana
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Alcohol Consumption ◽  
Pulmonary Tuberculosis ◽  
Prospective Cohort ◽  
People Living With Hiv ◽  
Active Pulmonary Tuberculosis ◽  
Highly Active ◽  
Associated Risk Factors ◽  
Living With Hiv

Background: People living with HIV/AIDS (PLWHA) were more susceptible of Active Pulmonary Tuberculosis (APT) than non-PLWHA. Whether Metronidazole Preventive Therapy (MPT) may prevent APT, remain unclear. The objective of the study was to investigate efficacy of MPT and other associated risk factors of APT among PLWHA on Highly Active Anti Retroviral Therapy (HAART).Methods: A prospective cohort study included 182 PLWHA on HAART and asymptomatic tuberculosis (TB), 62 received MPT (first group) and 120 PLWHA did not receive MPT (second group). APT were diagnosed among the first group (4 participants) and the second group (26 participants). Monthly visit to replenish pills and to confirm APT. Efficacy of MPT to prevent APT, socio-demography and laboratory, were analyzed using Chi-square with significancy p<0.05.Results: Of 112 participants (62.20%) were males, 70 (37.80%) females, mean age (year) 37.31±9.83. Four (2.20%) of participants (first group) and 26 (14.47%) (second group) were confirmed APT (p=0.003). In bivariate analysis, sex (p=0.020), alcohol consumption (p=0.000); smoking (p=0.000), CD4 cell counts (<70 cell/µl) (p=0.001), previous history of TB (p=0.000) were the significant factors associated with APT. Participants who received MPT had a significantly lower risk of APT than participants who did not receive MPT (p=0.003). Other factors; weight, Hb, WBC, neutrophil, lymphocyte, Neutrophil Lymphocyte Ratio (NLR) were not significantly associated with APT.Conclusions: We found, a significant protective effect of MPT, prevent APT. Other significant associated risk factors of APT were sex (male), smoking, alcohol consumption, previous TB history, lower CD4 counts.

Sign in / Sign up

Export Citation Format

Share Document