Use of non-antiretroviral drugs and polypharmacy among people living with HIV starting antiretroviral therapy in Belo Horizonte, Brazil

Authors

DOI:

https://doi.org/10.33448/rsd-v11i5.28301

Keywords:

Drug Utilization; Polypharmacy; Antiretroviral Therapy; HIV.

Abstract

The increase in life expectancy of individuals living with HIV has contributed to the manifestation of comorbidities due to multiple factors, such as HIV infection, use of antiretroviral drugs and aging. The use of other drugs and polypharmacy can compromise adherence to antiretroviral treatment due to potential drug interactions and adverse reactions. A cohort study was conducted with individuals living with HIV who started antiretroviral therapy (ART) in three specialized HIV/AIDS care services in Belo Horizonte, to describe the use of non-antiretroviral drugs and polypharmacy among treatment-naïve individuals in the period 12 months after starting ART. Data were collected through interviews, clinical records and computerized systems with data on the dispensing of antiretrovirals and laboratory tests of viral load and TCD4+ lymphocyte count. A total of 433 individuals were included, of which 70.0% had a record of using non-antiretroviral drugs concomitantly with ART and 7.9% of polypharmacy within 12 months of treatment. The most used therapeutic subgroups were antibacterials for systemic use (29.6%), antihistamines for systemic use (7.1%), antimycobacterials (4.8%), antimycotics (4.8%) and psychoanaleptics (4, 4%). The most used drugs were sulfamethoxazole and trimethoprim (10.8%), benzathine benzylpenicillin (6.3%), loratadine (5.7%), azithromycin (4.8%) and fluconazole (4.7%). The use of non-antiretroviral drugs in the first 12 months of treatment was high, with an important share in polypharmacy. The most used drugs correspond to indications for prophylaxis and treatment of opportunistic infections and antiretroviral toxicities.

References

Associação Brasileira de Empresas de Pesquisa – ABEP. (2008). Critério de classificação econômica. http://www.abep.org.

Back, D. & Marzolini, C. (2020). The challenge of HIV treatment in an era of polypharmacy. Journal of the International AIDS Society, 23(2), e25449. https://doi.org/10.1002/jia2.25449

Brasil. (2018). Protocolo clínico e diretrizes terapêuticas para o manejo da infecção pelo hiv em adultos. In Ministério da Saúde. Secretaria de Vigilância em

Saúde (1st ed., p. 410). Retrieved from http://www.aids.gov.br/pt-br/pub/2013/protocolo-clinico-e-diretrizes-terapeuticas-para-manejo-da-infeccao-pelo-hivem-adultos

Centers for Disease Control and Prevention – CDC. (1992). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 41(RR-17):1-19 https://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm

Coelho, L. E., Escada, R. O. S, Barbosa, H. P. D., Santos, V. G. V., & Grinsztejna, B. G. J. (2016). O tratamento da coinfecção HIV-TB. The Brazilian Journal of Infectious Diseases 2(5), 134-148.

Dash S., Balasubramaniam M., Villalta F., Dash C., & Pandhare J. (2015). Impact of cocaine abuse on HIV pathogenesis. Front. Microbiol. 6:1111. https://doi.org/10.3389/fmicb.2015.01111

Diouf, A., Youbong, T. J., Maynart, M., Ndoye, M., Diéye, F. L., Ndiaye, N. A., Koita-Fall M. B., Ndiaye B., & Seydi, M. (2017). Médicaments non antirétroviraux chez les personnes vivant avec le VIH sous traitement antirétroviral au Sénégal : coûts et facteurs associés à la prescription. Revue d’Épidémiologie et de Santé Publique, 65(4), 295–300. doi:10.1016/j.respe.2017.02.001

Gimeno-Garcia, M., Crusells-Canales, M. J., Javier Armesto-Gómez, F., & Rabanaque-Hernández, M. J. (2015). Prevalence of concomitant medications in older HIV+ patients and comparison with general population. HIV clinical trials, 16(3), 117–124. https://doi.org/10.1179/1528433614Z.0000000012

Gimeno-Gracia, M., Crusells-Canales, M. J., Armesto-Gómez, F. J., Compaired-Turlán, V., & Rabanaque-Hernández, M. J. (2016). Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population. Clinical interventions in aging, 11, 1149–1157. https://doi.org/10.2147/CIA.S108072

Hafeez, H., Zeshan, M., Tahir, M. A., Jahan, N., & Naveed, S. (2017). Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus, 9(4), e1184. https://doi.org/10.7759/cureus.1184

Justice, A. C., Gordon, K. S., Skanderson, M., Edelman, E. J., Akgün, K. M., Gibert, C. L., Lo Re, V., 3rd, Rimland, D., Womack, J. A., Wyatt, C. M., Tate, J. P., & VACS Project Team (2018). Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals. AIDS (London, England), 32(6), 739–749. https://doi.org/10.1097/QAD.0000000000001756

Kara, E., İnkaya, A. Ç., Aydın Haklı, D., Demirkan, K., & Ünal, S. (2019). Polypharmacy and drug-related problems among people living with HIV/AIDS: a single-center experience. Turkish journal of medical sciences, 49(1), 222–229. https://doi.org/10.3906/sag-1807-295

Knauth, D.R., Hentges, B., Macedo, J. L., Pilecco, F. B., Teixeira, L. B., & Leal, A. F. (2020). O diagnóstico do HIV/aids em homens heterossexuais: a surpresa permanece mesmo após mais de 30 anos de epidemia. Cad. Saúde Pública 36 (6). https://doi.org/10.1590/0102-311X00170118

Krentz, H. B., & Gill, M. J. (2016). The Impact of Non-Antiretroviral Polypharmacy on the Continuity of Antiretroviral Therapy (ART) Among HIV Patients. AIDS patient care and STDs, 30(1), 11–17. https://doi.org/10.1089/apc.2015.0199

López-Centeno, B., Badenes-Olmedo, C., Mataix-Sanjuan, Á., McAllister, K., Bellón, J. M., Gibbons, S., Balsalobre, P., Pérez-Latorre, L., Benedí, J., Marzolini, C., Aranguren-Oyarzábal, A., Khoo, S., Calvo-Alcántara, M. J., & Berenguer, J. (2020). Polypharmacy and Drug-Drug Interactions in People Living with Human Immunodeficiency Virus in the Region of Madrid, Spain: A Population-Based Study. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 71(2), 353–362. https://doi.org/10.1093/cid/ciz811

Mata-Marín, J. A., Martínez-Osio, M. H., Arroyo-Anduiza, C. I., Berrospe-Silva, M., Chaparro-Sánchez, A., Cruz-Grajales, I., Cruz-Herrera, J. E., Uribe-Noguez, L. A., Gaytán-Martínez, J. E., & Jerónimo-Morales, M. (2019). Comorbidities and polypharmacy among HIV-positive patients aged 50 years and over: a case-control study. BMC research notes, 12(1), 556. https://doi.org/10.1186/s13104-019-4576-6

Navarini, A. A., Stoeckle, M., Navarini, S., Mossdorf, E., Jullu, B. S., Mchomvu, R., Mbata, M., Kibatala, P., Tanner, M., Hatz, C., & Schmid-Grendelmeier, P. (2010). Antihistamines are superior to topical steroids in managing human immunodeficiency virus (HIV)-associated papular pruritic eruption. International journal of dermatology, 49(1), 83–86. https://doi.org/10.1111/j.1365-4632.2009.04279.x

Nascimento, R. C. R. M., Álvares, J., Guerra, A. A., Gomes, I. C., Silveira, M. R., Costa, E. A., Leite, S. N., Costa, K. S., Soeiro, O. M., Guibu. I. A., Karnikowski M. G. O., & Acurcio F. A. (2017). Polifarmácia: uma realidade na atenção primária do Sistema Único de Saúde. Rev. Saúde Pública 51 (suppl 2). https://doi.org/10.11606/S1518-8787.2017051007136

Nickel, K., Halfpenny, N., Snedecor, S. J., & Punekar, Y. S. (2021). Correction to: Comparative efficacy, safety and durability of dolutegravir relative to common core agents in treatment-naïve patients infected with HIV-1: an update on a systematic review and network meta-analysis. BMC infectious diseases, 21(1), 340. https://doi.org/10.1186/s12879-021-06016-8

Oliveira-Filho, A. D., Morisky, D. E., Neves, S. J., Costa, F. A., & de Lyra, D. P., Jr (2014). The 8-item Morisky Medication Adherence Scale: validation of a Brazilian-Portuguese version in hypertensive adults. Research in social & administrative pharmacy: RSAP, 10(3), 554–561. https://doi.org/10.1016/j.sapharm.2013.10.006

Righetto, R. C., Reis, R. K., Reinato, L. A. F., & Gir, E. (2014). Comorbidades e coinfecções em pessoas vivendo com HIV/Aids. Rev Rene. 15(6), 942-948. https://doi.org/10.15253/2175-6783.2014000600006

Siefried, K. J., Mao, L., Cysique, L. A., Rule, J., Giles, M. L., Smith, D. E., McMahon, J., Read, T. R., Ooi, C., Tee, B. K., Bloch, M., de Wit, J., Carr, A., & PAART study investigators (2018). Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy. AIDS (London, England), 32(1), 35–48. https://doi.org/10.1097/QAD.0000000000001685

Silva, A. L., Ribeiro A. Q., Klein, C. H., & Acurcio F. A. (2012). Utilização de medicamentos por idosos brasileiros, de acordo com a faixa etária: um inquérito postal. Cad. Saúde Pública 28(6):1033-1045.

World Health Organization – WHO. (2019). Medication safety in polypharmacy. https://apps.who.int/iris/bitstream/handle/10665/325454/WHO-UHC-SDS-2019.11-eng.pdf

World Health Organization – WHO. (2020). Guidelines for ATC classification and DDD assignment 2020. https://www.whocc.no/atc_ddd_index/.

Yombi J. C. (2018). Dolutegravir Neuropsychiatric Adverse Events: Specific Drug Effect or Class Effect. AIDS reviews, 20(1), 14–26.

Published

12/04/2022

How to Cite

SILVA , V. C. da .; MENDES, J. C.; SILVEIRA, M. R. .; VIOLANTE, T. A. .; OLIVEIRA, T. J. de .; BRAGA, M. das G. Use of non-antiretroviral drugs and polypharmacy among people living with HIV starting antiretroviral therapy in Belo Horizonte, Brazil . Research, Society and Development, [S. l.], v. 11, n. 5, p. e45211528301, 2022. DOI: 10.33448/rsd-v11i5.28301. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/28301. Acesso em: 20 apr. 2024.

Issue

Section

Health Sciences