Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Shelli Farhadian

Abstract

Background: Little is known on the impact of taking multiple medications in older people with HIV (PWH), who have higher rates of medical comorbidities than HIV uninfected individuals. We assessed the prevalence and clinical impact of polypharmacy among a large, mixed gender cohort of PWH, and assessed for the relationship between polypharmacy and clinical and laboratory-based biomarkers of cognitive frailty.Methods: We used data from the AIDS Clinical Trials Group (ACTG) A5322 (HAILO) cohort of PWH aged 40 or older with plasma HIV RNA levels below 200 copies/µL from 2013 to 2014 study visits. We assessed the relationship between polypharmacy (> 5 medications) and hyperpolypharmacy (> 10 medications) with three clinical and laboratory biomarkers associated with cognitive impairment and mortality: slow gait speed, recurrent falls, and plasma neurofilament light chain protein (NFL), a biomarker of neuronal injury. Multivariate regression analysis was utilized to assess the relationship between each of the biomarkers and polypharmacy. Results: One-thousand thirty-five participants were included in analysis of clinical outcome variables and a subset of 600 participants had available blood plasma to include in NFL analysis. The mean age of the study population is 51 years. A majority of the participants were male gender (81%). Excluding ART, 24% of study participants had polypharmacy and 4% had hyperpolypharmacy. After adjusting for demographic and clinical variables identified in univariate analyses, participants with polypharmacy had a higher risk of slow gait speed (Adjusted odds ratio (AOR) = 1.82 [95% CI=1.30, 2.55]). Participants with polypharmacy and hyperpolypharmacy have an increased risk of recurrent falls (AOR polypharmacy= 2.12 [95% CI=1.06, 4.23]) (AOR hyperpolypharmacy= 4.96 [95% CI=1.74, 14.13]. In a multivariate linear regression analysis, polypharmacy was associated with elevated plasma NFL, but hyperpolypharmacy was not (Slope Estimate = 0.15). Conclusions: In this large, mixed-sex cohort of PWH aged over 40, polypharmacy was associated with slow gait speed, recurrent falls, and plasma NFL. These results highlight the need for increased focus on identifying and managing polypharmacy and hyperpolypharmacy among PWH.

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This is an Open Access Thesis.

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