Among those with HIV infection (HIV+) on antiretroviral therapy (ART), polypharmacy is three times more common than among those without infection and occurs 10 years earlier. Likely due to greater physiologic frailty, polypharmacy (5+ chronic medications) among those with HIV is also associated with greater mortality. Potentially inappropriate medications (PIMs) are those which likely cause more harm than benefit due to drug interactions and adverse reactions and these increase with polypharmacy. While criteria for PIMs among 65+ year olds (Aging PIMs) are established, they have not been validated among HIV+ individuals. Further, ART and alcohol use also increase PIMs. We do not know which non ART pharmacotherapies (co medications) are helpful and which are actually harmful among HIV+ who drink. Conversely, HIV and alcohol use may also be a barrier to receipt of helpful co medications. In the face of limited evidence, providers may be reluctant to treat Alcohol Use Disorder (AUD) with medications among HIV+ individuals due to safety concerns. Further, alcohol use is a relative contraindication for HCV treatment. As a result, drinkers may choose to under report alcohol use to gain access to direct acting agents (DAAs) but may experience more harm and less benefit. We draw on the rich, longitudinal clinical data in the Veterans Aging Cohort Study and enhance it with strategic additional data collection and innovative techniques to correct for systematic error in measurement and confounding by indication. We will quantify the impact of Aging, ART and Alcohol PIMs and of pharmacotherapies for AUD and HCV on patient salient outcomes (PSOs) including mortality, hospitalization, medically significant falls, bacterial pneumonia, and delirium to inform prioritization of medications and limit harm from polypharmacy among HIV+ individuals. Our study is timely and innovative. Polypharmacy is the norm, AUD is under treated, and DAAs for HCV have only recently become available. While others have quantified PIMs, we will measure their actual impact on PSOs. We will also measure the benefit from pharmacotherapy for AUD and HCV among HIV+ and uninfected individuals who drink. These studies will be instrumental in the design of eHealth interventions facilitating personalized care and simplification of co medications among HIV+ individuals (see U24s CHAMP & RIB).

Public Health Relevance

We do not know which co medications are helpful and which are inappropriate among HIV+ who drink and take antiretroviral therapy.Using rich longitudinal data from the Veterans Aging Cohort Study (VACS) we will compare the impact of polypharmacy, potentially inappropriate medications, and pharmacologic treatment for alcohol use disorder and hepatitis C among those aging with and without HIV infection.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project--Cooperative Agreements (U01)
Project #
2U01AA020790-06
Application #
9206700
Study Section
Special Emphasis Panel (ZAA1-DD (10)V)
Program Officer
Roach, Deidra
Project Start
2011-09-10
Project End
2021-08-31
Budget Start
2016-09-01
Budget End
2017-08-31
Support Year
6
Fiscal Year
2016
Total Cost
$1,066,579
Indirect Cost
$134,063
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Grover, Surbhi; Desir, Fidel; Jing, Yuezhou et al. (2018) Reduced Cancer Survival Among Adults With HIV and AIDS-Defining Illnesses Despite No Difference in Cancer Stage at Diagnosis. J Acquir Immune Defic Syndr 79:421-429
Gaither, Julie R; Gordon, Kirsha; Crystal, Stephen et al. (2018) Racial disparities in discontinuation of long-term opioid therapy following illicit drug use among black and white patients. Drug Alcohol Depend 192:371-376
Hawkins, Kellie L; Gordon, Kirsha S; Levin, Myron J et al. (2018) Herpes Zoster and Herpes Zoster Vaccine Rates Among Adults Living With and Without HIV in the Veterans Aging Cohort Study. J Acquir Immune Defic Syndr 79:527-533
Williams, Emily C; McGinnis, Kathleen A; Bobb, Jennifer F et al. (2018) Changes in alcohol use associated with changes in HIV disease severity over time: A national longitudinal study in the Veterans Aging Cohort. Drug Alcohol Depend 189:21-29
Yanik, Elizabeth L; Hernández-Ramírez, Raúl U; Qin, Li et al. (2018) Brief Report: Cutaneous Melanoma Risk Among People With HIV in the United States and Canada. J Acquir Immune Defic Syndr 78:499-504
Halpin, Sean N; Carruth, Edwin Clayton; Rai, Ramona P et al. (2018) Complementary and Alternative Medicine Among Persons living with HIV in the Era of Combined Antiretroviral Treatment. AIDS Behav 22:848-852
Matson, Theresa E; McGinnis, Kathleen A; Rubinsky, Anna D et al. (2018) Gender and alcohol use: influences on HIV care continuum in a national cohort of patients with HIV. AIDS 32:2247-2253
Altekruse, Sean F; Shiels, Meredith S; Modur, Sharada P et al. (2018) Cancer burden attributable to cigarette smoking among HIV-infected people in North America. AIDS 32:513-521
Barry, Declan T; Marshall, Brandon D L; Becker, William C et al. (2018) Duration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care. Drug Alcohol Depend 191:348-354
Beckman, Joshua A; Duncan, Meredith S; Alcorn, Charles W et al. (2018) Association of Human Immunodeficiency Virus Infection and Risk of Peripheral Artery Disease. Circulation 138:255-265

Showing the most recent 10 out of 159 publications