Polypharmacy is associated with slow gait speed and recurrent falls in older people with HIV.

BACKGROUND:Older people with HIV (PWH) are prone to using multiple medications due to higher rates of medical comorbidities and the use of antiretroviral therapy (ART). We assessed the prevalence and clinical impact of polypharmacy among PWH. METHODS:We leveraged clinical 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. We assessed the relationship between polypharmacy (defined as the use of 5 or more prescription medications, excluding ART) and hyperpolypharmacy (defined as the use of 10 or more prescription medications) with slow gait speed (less than 1 meter/second) and falls, including recurrent falls. RESULTS:Excluding ART, 24% of study participants had polypharmacy and 4% had hyperpolypharmacy. Polypharmacy was more common in women (30%) than men (23%). Participants with polypharmacy had a higher risk of slow gait speed (Odds ratio (OR) = 1.78 [95% CI=1.27, 2.50]) and increased risk of recurrent falls (OR= 2.12 [95% CI=1.06, 4.23]). The risk for recurrent falls was further increased in those with hyperpolypharmacy compared to those without polypharmacy (OR = 3.46 [95% CI=1.32, 9.12]). CONCLUSIONS:In this large, mixed-sex cohort of PWH aged over 40, polypharmacy was associated with slow gait speed and recurrent falls, even after accounting for medical comorbidities, alcohol use, substance use, and other factors. These results highlight the need for increased focus on identifying and managing polypharmacy and hyperpolypharmacy in PWH.