Date of Award

January 2016

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Amy C. Justice

Abstract

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.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

Download

Share

COinS