Prescribing issues in older adults living with HIV: thinking beyond drug–drug interactions with antiretroviral drugs

Thanks to potent antiretroviral therapy, the life expectancy of people living with HIV (PLWH) has increased significantly and has become comparable to the general population.1–3 Consequently, this population is aging, living long enough to face age-related chronic comorbidities, including cardiovascular diseases, kidney disease, diabetes mellitus, chronic obstructive pulmonary disease, cancer, osteoarthritis or neurocognitive impairment.4–6 The age-related comorbidities burden leads inevitably to polypharmacy, which is commonly defined in HIV medicine as being on at least five concomitant non-HIV medications. The prevalence of polypharmacy has been shown to be high in different European and American HIV cohorts, ranging from 37% up to 94% in PLWH aged ⩾50 years up to ⩾75 years.7–12 Simulations based on the data of the Dutch HIV cohort ATHENA predicted that the median age would increase from 43 years in 2010 to 56 in 2030, resulting in 40% of HIV-infected individuals being 60 years old or older and 28% having at least three comorbidities. In 2030, about one-half of PLWH are anticipated to take comedications, compared with 13% in 2010, with 20% taking three or more comedications.13 Similar forecasts were obtained for Italian and US PLWH.14 Additional prescribing issues are emerging with the aging of the HIV population.