ABSTRACT
OBJECTIVE: HIV+ patients have increased their life expectancy with a parallel increase in age-associated co-morbidities and pharmacotherapeutic complexity. The aim of this study was to determine an optimal cutoff value for Medication regimen complexity index (MRCI) to predict polypharmacy in HIV+ older patients. METHODS: A transversal observational single cohort study was conducted at a tertiary Hospital in Spain, between January 1st up to December 31st, 2014. Patients included were HIV patients over 50 years of age on active antiretroviral treatment. Prevalence of polypharmacy and it pattern were analyzed. The pharmacotherapy complexity value was calculated through the MRCI. Receiver operating characteristic curve analyses were used to calculate the area under the curve (AUC) for the MRCI value medications to determine the best cutoff value for identifying outcomes including polypharmacy. Sensitivity and specificity were also calculated. RESULTS: A total of 223 patients were included. A 56.1% of patients had polypharmacy, being extreme polypharmacy in 9.4% of cases. Regarding the pattern of polypharmacy, 78.0% had a cardio-metabolic pattern, 12.0% depressive-psychogeriatric, 8.0% mixed and 2.0% mechanical-thyroidal. The ROC curve demonstrated that a value of medication complexity index of 11.25 point was the best cutoff for predict polypharmacy (AUC=0.931; sensitivity= 77.6%; specificity=91.8%). CONCLUSIONS: A cut-off value of 11.25 for MRCI is proposed to determine if a patient reaches the criterion of polypharmacy. In conclusion, the concept of polypharmacy should include not only the number of prescribed drugs but also the complexity of them.
Subject(s)
Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , Polypharmacy , Age Factors , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , ROC Curve , Sensitivity and SpecificityABSTRACT
Fundamento: El objetivo del estudio fue caracterizar a las personas que demandaron la prueba rápida VIH en Andalucía. Métodos: Estudio trasversal realizado por las entidades sociales colaboradoras del Programa de diagnóstico precoz del VIH en Andalucía. Los participantes fueron personas que demandaron la prueba en fluido oral y que contestaron una encuesta previa a la misma entre septiembre de 2013 y agosto de 2014. Se realizó un análisis descriptivo y de regresión logística para determinar los factores de riesgo asociados a un resultado reactivo. Se analizaron variables relacionadas con: entidad que realizó la prueba, características sociodemográficas, exposición de riesgo, antecedentes de cribado, antecedentes de infecciones de transmisión sexual (variables predictivas) y resultado de la prueba (variable dependiente). Resultados: Las personas caracterizadas fueron 1.844 (48%), en su mayoría hombres (70%) que practicaron sexo con otros hombres (HSH) en los últimos 12 meses (59%). El 53% tenía antecedentes de cribados y acudieron tras una exposición de riesgo, principalmente de sexo desprotegido oral (75%), vaginal (50%) y/o anal (38%). El 23% fueron extranjeros. Los factores asociados a un resultado reactivo fueron: entidades especializadas en VIH, sexo masculino, HSH, realización de sexo desprotegido (anal, con persona VIH+ y/o con trabajador/a del sexo) y tener antecedente de cribado (p<0,05). La significación estadística del sexo masculino y de las prácticas desprotegidas se mantuvo en el estudio multivariante. Conclusiones: Se ha logrado caracterizar a un elevado número de personas (alrededor del 50%), lo que favorecerá la adecuación de la recogida de información y la mejora del Programa (AU)
Background: The aim of the study was to describe people who demanded the HIV screening test in Andalusia (Spain). Design: Cross-sectional study carried out by social organisation collaborating with the Program for early diagnosis of HIV in Andalusia. Participants underwent an oral HIV test and answered a survey beforehand, from September 2013 to August 2014. The study included a descriptive analysis of data and a logistic regression in order to determine the risk factors associated with a reactive test result. We analysed variables related to: social organisation, sociodemographic characteristics, risk exposure that caused the test, previous test history, history of sexually transmitted infections (predictive variables) and test result (dependent variable). Results: It was possible to characterise 1,844 people (48%). They were mostly men (70%) who had sex with men (MSM) in the last 12 months (59%). The 53% had a previous HIV test and came to social organisations after an exposure to risk, especially unprotected oral sex (75%), vaginal (50%) and/or anal (38%). Twenty-three percent was foreigners. A positive result was associated to: HIV work area, male sex, MSM, unprotected sex (anal, with HIV+ person or with sex worker) and test antecedent (p<0.05). These unprotected practices and male sex were also significant in the multivariate analysis. Conclusions: This approach of the study made it possible to characterise a great number of people (around 50%). These results will guide improvements in the Program's data collection and future community interventions (AU)