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Antiretroviral therapy adherence and drugdrug interactions in the aging HIV population

Nachega, Jean B.a,b,c; Hsu, Alice J.d; Uthman, Olalekan A.e; Spinewine, Annef; Pham, Paul A.g

doi: 10.1097/QAD.0b013e32835584ea
Supplement Articles

It is estimated that by 2015 more than half of all HIV-infected individuals in the United States will be 50 years of age or older. As this population ages, the frequency of non-AIDS related comorbidities increases, which includes cardiovascular, metabolic, gastrointestinal, genitourinary and psychiatric disorders. As a result, medical management of the aging HIV population can be complicated by polypharmacy and higher pill burden, leading to poorer antiretroviral therapy (ART) adherence. Adherence to ART is generally better in older populations when compared to younger populations; however, cognitive impairment in elderly patients can impair adherence, leading to worse treatment outcomes. Practical monitoring tools can improve adherence and increase rates of viral load suppression. Several antiretroviral drugs exhibit inhibitory and/or inducing effects on cytochrome P450 isoenzymes, which are responsible for the metabolism of many medications used for the treatment of comorbidities in the aging HIV population. The combination of ART with polypharmacy significantly increases the chance of potentially serious drug–drug interactions (DDIs), which can lead to drug toxicity, poorer ART adherence, loss of efficacy of the coadministered medication, or virologic breakthrough. Increasing clinicians awareness of common DDIs and the use of DDI programs can prevent coadministration of potentially harmful combinations in elderly HIV-infected individuals. Well designed ART adherence interventions and DDI studies are needed in the elderly HIV population.

aDepartment of International Health

bDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

cDepartment of Medicine and Centre for Infectious Diseases, Stellenbosch University, Faculty of Health Sciences Cape Town, Cape Town, South Africa

dDepartment of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA

eDepartment of Primary Care Sciences, Faculty of Health Sciences, Keele University, Keele, Staffordshire, UK

fUniversité catholique de Louvain, Louvain Drug Research Institute, Brussels, and CHU Mont-Godinne, Yvoir, Belgium

gDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Correspondence to Jean B. Nachega, MD, PhD, Global Disease Epidemiology and Control Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615N Wolfe Street, Suite W5031, Baltimore, MD 21205, USA. Tel: +1 410 955 2378; fax: +1 410 502 6733; e-mail:

Received 12 December, 2011

Accepted 23 April, 2012

© 2012 Lippincott Williams & Wilkins, Inc.