Publications & Reports

Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive ART.

Siefried KJ, Mao L, Cysique LA, Rule J, Giles ML, Smith DE, Mcmahon J, Read TR, Ooi C, Tee BK, Bloch M, de Wit J, Carr A; PAART study investigators.
aSt Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia bCentre for Social Research in Health, University of New South Wales, Sydney, Australia cNeuroscience Research Australia, University of New South Wales, Sydney, Au

Abstract

OBJECTIVES: We quantified concomitant medication (CM) polypharmacy, pharmacokinetic (PK) and pharmacodynamic (PD) interactions, adverse effects and adherence in Australian adults on effective ART. DESIGN: Cross-sectional. METHODS: Patients recruited into a nation-wide cohort and assessed for prevalence and type of CM (including polypharmacy, defined as >/=5 CMs), PK or PD interactions, potential CM adverse effects and CM adherence. Factors associated with CM polypharmacy and with imperfect adherence were identified using multivariable logistic regression. RESULTS: Of 522 participants, 392 (75%) took a CM (mostly cardiovascular, non-prescription or antidepressant). Overall, 280 participants (54%) had polypharmacy of CMs and/or a drug interaction or contraindication. Polypharmacy was present in 122 (23%) and independently associated with: clinical trial participation, renal impairment, major comorbidity, hospital/general practice-based HIV care (vs. sexual health clinic), and benzodiazepine use. Seventeen participants (3%) took >/=1 CM contraindicated with their ART; and 237 (45%) had at least one PK/PD interaction. CM use was significantly associated with sleep disturbance and myalgia; and polypharmacy of CMs with diarrhoea, fatigue, myalgia and peripheral neuropathy. Sixty participants (12%) reported imperfect CM adherence, independently associated with: requiring financial support, foregoing necessities for financial reasons, good/very good self-reported general health, and >/=1 bed day for illness in the previous 12 months. CONCLUSIONS: In a resource-rich setting with universal healthcare access, the majority of this sample took a CM. Over half had at least one of CM polypharmacy, PK, or PD interaction. Concomitant medication use was associated with several adverse clinical outcomes.

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Publication

  • Journal: AIDS (London, England)
  • Published: 02/01/2018
  • Volume: 32
  • Issue: 1
  • Pagination: 35-48

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