High prevalence of polypharmacy and nervous system medications in people with HIV: a cross-sectional analysis

Polypharmacy is increasingly prevalent among people living with HIV (PLWH), especially as they age and manage multiple comorbidities. This cross-sectional study analyzed data from 268 PLWH in Vigo, Spain (2020-2023), revealing an aging cohort (mean age 49.8 years) and a 51.9% prevalence of multimorbidity. Descriptive, bivariate, and multivariable logistic regression analyses were performed. Polypharmacy, defined as the chronic use of ≥ 5 non-antiretroviral drugs, was observed in 35.7% of participants, increasing among older adults (≥ 50 years, 50.7%; p < 0.001) and those living with HIV for > 10 years (43.0%; p = 0.004). Nervous system medications (47.0%), alimentary tract/metabolism drugs (36.2%), and cardiovascular drugs (34.3%) were the most common. Psychotropic drugs were frequent, particularly anxiolytics (24.8%) and antidepressants (22.9%). In multivariable analysis, anxiolytic use was associated with older age (OR = 1.03; p = 0.038), female sex (OR = 1.97; p = 0.042), current smoking (OR = 3.74; p = 0.002), and past cocaine use (OR = 2.52; p = 0.008); antidepressant use with past (OR = 3.46; p = 0.015) and current smoking (OR = 4.46; p = 0.001). These findings highlight the complexity of managing polypharmacy in aging PLWH and underscore the need for strategies to optimize medication use.