TOPLINE:

Among older adults living with HIV, more than half experienced polypharmacy, with 49.3% taking potentially inappropriate medications (PIMs) and 55.7% having a high sedative burden. These medication-related factors were associated with nearly twofold increased risks for falls and frailty.

METHODOLOGY:Researchers conducted a cross-sectional analysis of an ongoing prospective cohort (CHANGE-HIV) to determine the prevalence of polypharmacy and its association with frailty and falls among older adults with HIV infection.They included 440 patients (median age, 69 years; 91.6% men; median time since HIV diagnosis, 26 years) from seven centers in Canada.Polypharmacy (prescription of 5 or more nonantiretroviral drugs), severe polypharmacy (prescription of 10 or more nonantiretroviral drugs), PIMs, and anticholinergic and sedative burdens were determined through validated tools.Frailty (defined as meeting three or more criteria of the Fried frailty phenotype) and fall history (number of falls and recurrent falls within the previous 6 months) were assessed while accounting for potential confounders.TAKEAWAY:Polypharmacy was present in 54% of patients, with 15% experiencing severe polypharmacy and 49.3% having at least one PIM; high anticholinergic and sedative burdens were present in 16.5% and 55.7%, respectively.The risk for frailty more than doubled among those with a high sedative burden (odds ratio [OR], 2.59; 95% CI, 1.35-4.96), a high anticholinergic burden (OR, 3.34; 95% CI, 1.76-6.31), and severe polypharmacy (OR, 2.85; 95% CI, 1.47-5.53).The risk for falls in the previous 6 months was also elevated among those with a high sedative burden (OR, 1.85; 95% CI, 1.04-3.29) and one or more PIM (OR, 1.82; 95% CI, 1.06-3.14), with each additional PIM increasing the risk for falls by 25%.IN PRACTICE:

“Addressing polypharmacy, PIMs, anticholinergic, and sedating medications should be prioritized in older adults living with HIV. Identifying and deprescribing/tapering common PIMs would be a reasonable first step that can be accomplished during a clinic visit,” the authors of the study wrote.

SOURCE:

This study was led by Julian J. Hopwood-Raja, PharmD, Alberta Health Services, Kaye Edmonton Clinic, Edmonton, Alberta, Canada. It was published online on June 27, 2025, in AIDS.

LIMITATIONS:

The study cohort consisted predominantly of White men, which potentially limited the generalizability of the findings to women and other ethnic groups. The authors could not determine which of the medication-related factors were independently associated with falls or frailty. Some components of PIMs could not be evaluated because they were not collected in the CHANGE-HIV cohort. Moreover, prescribing omissions that might have contributed to increased risks for falls and frailty were not identified.

DISCLOSURES:

This study was supported by the Canadian Institutes of Health Research and Canadian HIV Trials Network. One author disclosed holding the Speck Family Chair in Emerging Infectious Diseases. Other authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.