- As people with HIV age, their burden of non-HIV medications can increase
- Researchers found that more than 50% of older adults with HIV take at least five non-HIV drugs
- Taking five or more non-HIV medications was associated with an increased risk of frailty and falls
Thanks to HIV treatment (antiretroviral therapy, ART), many people with HIV are living long, healthy lives. The impact of ART is so profound that researchers increasingly project that many ART users will live well into their senior years.
As ART users age, the risk for comorbidities increases, just as it does for people without HIV. Older people in general tend to have health issues such as high blood pressure, high levels of bad cholesterol (LDL-C), and so on. As they age, people with HIV are being prescribed more medicines to manage these comorbidities.
Researchers have found that older people without HIV are taking multiple prescribed medicines for comorbidities—this is called polypharmacy. Studies have found that although multiple medications may be necessary for some people, in other people the prescriptions may be excessive and may increase the risk of problems such as falls.
Study details
A team of researchers involved in a study called CHANGE-HIV analyzed health-related information collected from 440 older people (aged 65 to 89) with HIV at seven major Canadian clinics.
A brief average profile of participants upon entering the study was as follows:
- age – 69 years
- 92% were assigned male sex at birth; 8% were assigned female sex at birth
- major ethno-racial groups – White – 76%; Black – 13%
- time since HIV diagnosis – 26 years
- proportion with viral suppression – 93%
Key findings
In reviewing the data, researchers made the following findings about all participants:
- 16% were frail
- 21% had experienced a fall in the past six months
- 54% had polypharmacy (taking five or more non-HIV medicines); 30% of these people had what the researchers called “severe polypharmacy” (taking 10 or more non-HIV medicines)
- nearly 50% had what the researchers called “potentially inappropriate medications”
- the most common comorbidities were abnormal lipid levels (50%), high blood pressure (44%) and cancer (29%)
Signaling between cells
As mentioned earlier, doctors prescribe medicines to manage comorbidities. Apart from their intended effects, some medicines can have side effects. Specifically, the researchers assessed participants’ non-HIV medicines to find out if they had an inhibiting effect on the neurotransmitter acetylcholine (this is used to send messages between cells). Medicines that have an inhibiting effect on acetylcholine are called anticholinergic drugs. In theory, by interfering with messages sent between cells (particularly between brain cells, or brain cells and nerves and muscles), anticholinergic drugs could increase the risk of dizziness and falls.
Links between interference with signaling and falls
Statistical analysis found that in participants who had a high burden of anticholinergic drugs and/or drugs that caused them to be drowsy during the daytime, the risk of frailty was increased about three times above that of people who did not have a high burden of such drugs.
People who had a high burden of sedating drugs or what the researchers called “potentially inappropriate medications” were twice as likely to fall compared to people without a high medication burden.
Potentially inappropriate medications (PIMs)
According to the researchers, the most common PIMs were as follows:
- proton pump inhibitors (used to reduce excess stomach acid) – 20%
- aspirin – 10%
- testosterone “without a specified [reason for prescribing]” – 10%
- benzodiazepines (a class of drug related to Valium) – 9%
For every additional PIM, researchers found that the risk of falls increased by 25%.
An important note
As mentioned earlier, doctors prescribe medicines to treat or prevent comorbidities. Sometimes it is medically necessary for people to be taking many non-HIV medicines. This is often the case after a heart attack or stroke or in people with multiple or complex underlying health conditions.
However, in some cases, a person’s health changes, and it may no longer be necessary to take as many non-HIV medicines as before. Regular checkups with a physician and pharmacist can be useful, so that a person’s medication burden can be minimized.
Bear in mind
The researchers found that polypharmacy was common—found in 54% of participants. And nearly 30% of people with polypharmacy had what the researchers called severe polypharmacy—taking 10 or more non-HIV medicines.
Studies done in Switzerland, the UK and other countries suggest that as people with HIV age and accumulate comorbidities, their risk of polypharmacy increases. These studies support the findings from CHANGE-HIV.
The present study assessed data collected at one point in time (this type of study design is called cross-sectional). As a result, the researchers cautioned that they cannot prove that an increasing burden of non-HIV medicines caused frailty or increased the risk of falls in the study. However, such a link is possible.
The researchers noted that participants were overwhelmingly male, and a majority were White. This may limit the applicability of their findings to other populations. They also stated that it is possible that they under-detected the number of PIMs in the study. Nevertheless, the present study is a valuable addition to emerging research on polypharmacy, frailty and falls among people with HIV.
What to do?
The Canadian researchers encourage clinicians caring for people with HIV to “incorporate a geriatric approach to managing non-HIV co-medications and evaluating their anticholinergic and sedating properties.”
The researchers made the following statement: “Addressing polypharmacy, PIMs, anticholinergic and sedating medications should be prioritized in older adults living with HIV. Identifying and deprescribing/tapering common PIMs would be a reasonable first step that can be accomplished during a clinic visit. There are multiple tools, including clinician-focused websites, that can provide guidance on how to safely deprescribe medications,” such as the following listed by the researchers:
—Sean R. Hosein
REFERENCES:
- Hopwood-Raja JJ, Tseng AL, Sheehan NL, et al. CHANGE-Rx: frailty, falls, polypharmacy, and inappropriate medication use in a Canadian cohort of people aged 65 and older living with HIV. AIDS. 2025; in press.
- Collins LF, Cunningham SA, Vaughan CP, et al. Promoting healthy aging in people with HIV—into a new era. JAMA. 2025; in press.