Evidence map›Paper›PMID 34870254›Full record

Observational studyThe lancet. Healthy longevity2021

Polypharmacy-associated risk of hospitalisation among people ageing with and without HIV: an observational study.

Amy C Justice, Kirsha S Gordon, Jonathon Romero, E Jennifer Edelman, Benjamin J Garcia, Piet Jones, Saye Khoo, Vincent Lo Re, Christopher T Rentsch, Janet P Tate and 3 more

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The lancet. Healthy longevity, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 1 pooled it
2.9field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Review
  5. Article
  6. Review
  7. Article
  8. Article
  9. Article
  10. Observational
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  12. Outcomes of Bariatric Surgery in People With Human Immunodeficiency Virus: A Retrospective Analysis From the ATHENA Cohort.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023
    Article
  13. Article
  14. Article
  15. Review
  16. Article
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  18. Article
  19. Aging with HIV: Increased Risk of HIV Comorbidities in Older Adults.International journal of environmental research and public health · 2022
    Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 4 institutions in 3 countries.

Amy C JusticeSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Kirsha S GordonSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Jonathon RomeroSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
E Jennifer EdelmanSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Benjamin J GarciaSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Piet JonesSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Saye KhooSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Vincent Lo ReSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Christopher T RentschSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Janet P TateSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Alice TsengSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Julie WomackSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
Daniel JacobsonSchool of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack).
University of Tennessee at Knoxville · USVA Connecticut Healthcare System · USUniversity Health Network · CAYale University · US

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Alcohol Associated Outcomes Among HIV+/- Aging VeteransU10AA013566 · NIAAA · YALE UNIVERSITY · PI JUSTICE, AMY CAROLINE · 2006 to 2010
$12.7M
Alcohol and Multisubstance Use in the Veterans Aging Cohort StudyU01AA020790 · NIAAA · YALE UNIVERSITY · PI JUSTICE, AMY CAROLINE · 2011 to 2020
$7.7M
Sex Disparities in Overall Response to ART Among HIV Infected IndividualsU24AA020794 · NIAAA · YALE UNIVERSITY · PI JUSTICE, AMY CAROLINE · 2011 to 2020
$5.5M
Medical Research Council MR/V020498/1NCATS NIH HHS UL1 TR001863NIAAA NIH HHS U01 AA020790NIAAA NIH HHS U10 AA013566NIAAA NIH HHS U24 AA020794
6 · The paper itself

Abstract

backgroundPolypharmacy, defined as use of five or more medications concurrently, is associated with adverse health outcomes and people ageing with HIV might be at greater risk than similar uninfected individuals. We aimed to determine whether known pairwise drug interactions (KPDIs) were associated with risk of admission to hospital (hereafter referred to as hospitalisation) and medication count among people ageing with and without HIV after accounting for physiological frailty.

methodsIn this observational study, we collected individual-level data for participants of the Veterans Aging Cohort Study (VACS) with HIV on antiretroviral therapy (ART) and with supressed HIV-1 RNA and people without HIV who were receiving at least one prescription medication, based on active medications in the 2009 fiscal year (ie, Oct 1, 2008, to Sept 30, 2009). We identified KPDIs among these patients by linking prescription fill and refill data with data from DrugBank (version 5.0.11). We collected data on all-cause mortality and hospitalisations between Oct 1, 2009, and March 31, 2019. We compared KPDI counts using random selection and actual patterns of use across medication counts from two to 12. We created a weighted KPDI Index on the basis of the average association of each KPDI with mortality among people ageing without HIV and used nested Cox models stratified by HIV status to estimate the association between medication count and hospitalisation, with incremental adjustments for demographics, physiological frailty, and KPDI Index.

findingsWe collected data for 9186 people ageing with HIV and 37 930 individuals without HIV. 45 913 (97·4%) of 47 116 patients were men and the sample was predominantly aged 50-64 years (30 413 [64·6%]). Compared with a random sample of medications, real-world pattern of medication counts and combinations were associated with five-to-six times more KPDIs (eg, for a combination of six medications, KPDI count was 1·09 in the random sample, 5·49 in the HIV-negative population, and 7·13 in the HIV-positive population). For each additional observed medication, people ageing with HIV had approximately 2·94 additional KPDIs and comparators had approximately 2·67 additional KPDIs. Adjustment for demographics, physiological frailty, and KPDI Index reduced the association between medication count and risk of hospitalisation for people ageing with HIV (hazard ratio 1·08 [95% CI 1·07-1·09] reduced to 1·06 [1·05-1·07]) and those without HIV (1·08 [1·07-1·08] reduced to 1·04 [1·03-1·05]).

interpretationFor each additional medication, people ageing with HIV have more drug-drug interactions than those without HIV. Adjusting for known non-ART drug-drug interactions, each additional non-ART medication confers excess risk of hospitalisation for people ageing with HIV. Randomised trials will be needed to determine whether reducing these interactions improves outcomes.

fundingNational Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Department of Veterans Affairs Health Services Research & Development, and Office of Research and Development.

Indexed as

FrailtyHIV InfectionsHIV SeropositivityAgingCohort StudiesFemaleHospitalizationHumansMalePolypharmacy

Identifiers

PMID34870254
PMCPMC8639138
OpenAlexW3202820510

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.