Polypharmacy And The Adapted Frailty-Related Phenotype In Hiv-Infected And Uninfected Veterans

Polypharmacy is associated with frailty in the general population, but little is known about polypharmacy among aging HIV-infected individuals on antiretroviral therapy (HIV+). The purpose was to determine the association between polypharmacy and an adapted frailty-related phenotype (aFRP) in HIV+ and uninfected veterans. This was a cross-sectional study from October 2008 - September 2009. The study participants were 1762 HIV+ on antiretroviral (ARV) and 2679 uninfected veterans in the Veterans Aging Cohort Study who completed a survey. The primary predictor was number of long-term non-ARV medications (prescribed for 90 consecutive days allowing for a 30 day gap between refills), which was measured using electronic pharmacy fill/refill data. The outcome was aFRP and its components (shrinking, exhaustion, slowness, low physical activity), based on survey data. According to established methods, participants with ≥3 components were frail. We evaluated those with at least 1 component of the aFRP. Frailty was uncommon (2% of HIV+, 3% of uninfected); a larger proportion demonstrated at least one component of aFRP (31% HIV+, 41% uninfected). Among HIV+ and uninfected, the median number of long-term non-ARV medications was 6 and 16 respectively for those with aFRP components and 4 and 10 for those without aFRP components. In adjusted analyses, each additional long-term non-ARV medication conferred an 11% increased odds of having aFRP components in HIV-infected participants and a 4% increased odds in those who were uninfected [HIV+ (OR [95% CI] = 1.11 [1.08, 1.14]); HIV- (OR [95% CI] = 1.04 [1.03, 1.04]). While components of aFRP were commonly reported, few had more than one. Long-term non-ARV medication count was strongly associated with components of aFRP. The strong association between polypharmacy and frailty in aging individuals warrants further study