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Deprescribing of non-antiretroviral therapy in HIV-infected patients

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Abstract

Purpose

In recent decades, the life expectancy of HIV-infected patients has increased considerably, to the extent that the disease can now be considered chronic. In this context of progressive aging, HIV-infected persons have a greater prevalence of comorbid conditions. Consequently, they usually take more non-antiretroviral drugs, and their drug therapy are more complex. This supposes a greater risk of drug interactions, of hospitalization, falls, and death. In the last years, deprescribing has gained attention as a means to rationalize medication use.

Methods

Review of the different therapeutic approach that includes optimization of polypharmacy and control and reduction of potentially inappropriate prescription.

Results

There are several protocols for systematizing the deprescribing process. The most widely used tool is the Medication Regimen Complexity Index, an index validated in HIV-infected persons. Anticholinergic medications are the agents that have been most associated with major adverse effects so, various scales have been employed to measure it. Other tools should be employed to detect and prevent the use of potentially inappropriate drugs. Prioritization of candidates should be based, among others, on drugs that should always be avoided and drugs with no justified indication.

Conclusions

The deprescribing process shared by professionals and patients definitively would improve management of treatment in this population. Because polypharmacy in HIV-infected patients show that a considerable percentage of patients could be candidates for deprescribing, we must understand the importance of deprescribing and that HIV-infected persons should be a priority group. This process would be highly feasible and effective in HIV-infected persons.

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Acknowledgments

We thank Gesida (Grupo de Estudio del Sida-SEIMC) and the SEFH-VIH (Sociedad Española de Farmacia Hospitalaria – VIH) for the support provided for this document.

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  1. José-Ramón Blanco and Ramón Morillo contributed equally to this work.

Authors and Affiliations

  1. Hospital Universitario San Pedro – CIBIR de Logroño, Logroño, La Rioja, Spain

    José-Ramón Blanco

  2. Hospital Valme de Sevilla, 41001, Seville, Spain

    Ramón Morillo & Aguas Robustillo

  3. Hospital General Universitario de Valencia, 46014, València, Valencia, Spain

    Vicente Abril

  4. Hospital Infanta Leonor del Madrid, Universidad Complutense, 28040, Madrid, Spain

    Ismael Escobar & Fátima Brañas

  5. Hospital General Universitario Reina Sofía de Murcia, 30003, Murcia, Spain

    Enrique Bernal

  6. Hospital Puerta de Hierro de Madrid, 28222, Majadahonda, Madrid, Spain

    Carlos Folguera

  7. Hospital Lozano Blesa de Zaragoza, 50009, Zaragoza, Spain

    Mercedes Gimeno

  8. Hospital de Urduliz, Bizkaia, 48610, Urduliz, Biscay, Spain

    Olatz Ibarra

  9. Hospital Universitario Donostia, Instituto BioDonostia de San Sebastián, 20014, San Sebastián, Spain

    José-Antonio Iribarren

  10. Hospital de Guadalajara, 19002, Guadalajara, Spain

    Alicia Lázaro

  11. Complejo Hospitalario Universitario de Ferrol, 15405, Ferrol, A Coruña, Spain

    Ana Mariño

  12. Hospital Clinic de Barcelona, 08036, Barcelona, Spain

    María-Teresa Martín, Esteban Martinez & Montse Tuset

  13. Hospital de León, 24008, León, Spain

    Luis Ortega

  14. Hospital Costa del Sol de Marbella, 29603, Marbella, Málaga, Spain

    Julian Olalla & Javier de la Torre

  15. Hospital Ramón y Cajal de Madrid, 28034, Madrid, Spain

    Matilde Sanchez-Conde & Miguel-Angel Rodriguez

  16. Hospital de Getafe, 28905, Getafe, Madrid, Spain

    Javier Sanchez-Rubio

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  1. José-Ramón Blanco
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on behalf of Gesida and SEFH

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All authors have contributed to the review and writing process of the article. The coordinators have been JRB and RM.

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Correspondence to José-Ramón Blanco or Ramón Morillo.

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Blanco, JR., Morillo, R., Abril, V. et al. Deprescribing of non-antiretroviral therapy in HIV-infected patients. Eur J Clin Pharmacol 76, 305–318 (2020). https://doi.org/10.1007/s00228-019-02785-z

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