| Summary: | Introduction
We examined comorbidities, comedications
and polypharmacy among people living with HIV (PLHIV)
and associated challenges with HIV antiretroviral therapy
(ART).
Methods
A cross-sectional design was used in web-based
surveys conducted during 2019 in France, Germany, Italy, and
the UK. Pooled sample comprised 120 internists/infectious
disease specialists managing ≥50 HIV patients, and 1171
adult PLHIV combined who participated in two separate
surveys, the Positive Perspective Survey (n=483), and the
Unmet Needs Survey (n=688). The outcomes were perceptions and behaviors towards ART
based on PLHIV and healthcare provider (HCP) perspectives.
Results
According to HIV physicians, challenges associated
with comedications were a major reason for their patients
not starting ART, or stopping, switching, or skipping their
HIV treatment after they started. In total, 16.8% of providers
indicated that their patients had not started ART because of
medical reasons/comorbidities that interfered with dosing
(France 21.7%, Germany 15.4%, Italy 6.9%, and UK 24.1%).
Other reasons cited by providers for patients not starting
HIV treatment were: concerns about drug tolerability/
side effects (overall 34.6%, France 39.1%, Germany 34.6%,
Italy 27.6%, and UK 37.9%); concerns about long-term
toxicities (overall 26.2%, France 39.1%, Germany 26.9%,
Italy 24.1%, and UK 17.2%), as well as concerns about drugdrug
interactions (overall 16.8%, France 13.0%, Germany
26.9%, Italy 17.2%, and UK 10.3%). Averaged across all
ART regimen types, the percentage of PLHIV in the Unmet
Needs Study who indicated that they needed monitoring
when taking other medications with their ART was 5.8%,
15.9%, and 24.1% among those with none, 1, or ≥2 non-HIV
comorbidities, respectively. Within the Positive Perspectives
Survey, overall prevalence of polypharmacy was 38.8%
(France 41.9%,Germany 24.2%, Italy 40.8%, and UK 48.0%).
Compared to those without polypharmacy, those reporting
polypharmacy had lower odds of reporting viral suppression
(adjusted odds ratio, AOR=0.40) and optimal overall health
(AOR=0.65); they were however more likely to be worried
about taking more medicines as they grew older (AOR=2.15),
and to be more concerned how their ART might affect other
medicines they took (AOR=2.35) (all p<0.05).
Conclusions
A significant unmet need remains for PLHIV
relating to co-management of comorbidities and associated
challenges such as polypharmacy. Polypharmacy was
associated with suboptimal self-rated health and concerns
about the risk of long-term negative impacts from ART
intake. Holistic care that provides simplified regimens to
medically complex patients can help improve treatment
outcomes.
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