El Dr. Saye Khoo interviene en la sesión plenaria de este jueves para tratar los retos del TAR en la era de la polifarmacia.
What are the main challenges of ART in the era of polypharmacy?
In the era of ageing, multimorbidity and polypharmacy, DDIs are inevitable. That’s not a major issue usually, since they are mostly manageable, and not all DDIs lead to harm. The most important thing is to know exactly what your patient is taking, and with multiple teams and health services involved this is especially challenging. So- a full medicines reconciliation (asking specifically about herbal/recreational drugs, contraception, over-the-counter, injectable or inhaled medications) at least once a year and at every therapeutic crossroads is vital.
Is deprescription one of the best options to avoid negative interactions between treatments?
Whenever posible, yes. This is especially true for patients who are frail and with an accumulating anticholinergic burden from medications. In practice, multiple morbidities need multiple medications, and this simply cannot be avoided a lot of the time.
With a growing population of people with HIV and old age, where does the future of ART use and chronic pathology treatments go?
Theres no doubt that unboosted integrases and newer NNRTIs are valuable in helping to manage patients with multiple morbidities and polypharmacy, and the risk of DDIs have markedly reduced with these drugs. That said, there are still significant numbers of patients requiring boosted Pis, and one worry is that fear of DDIs can lead some of these comorbidities to be poorly managed.
Do you consider essential to improve multidisciplinary collaboration and the xchange of information between the health workers in charge of HIV management and the specialists in charge of treating other chronic pathologies present in the patient?
Not just essential- but vital. Electronic health records were supposed to sort this out, but we have found (in what is still a long transition for us in the UK) we are using multiple electronic systems, not all of which are linked.