INTRODUCTION
Aging of the general population reveals a series of challenges that must
be addressed and resolved. This is especially true with respect to
adverse drug reactions (ADRs) in elderly people, including drug-induced
morbidity among patients admitted to hospital, which is a major health
problem. In addition to the effects on the patient, the consequent
increase in health care costs is not inconsiderable. One study estimated
total expenditure on medical care related to the use of potentially
inappropriate medication to be $7.2 billion in the United States in
2001 [1].
Prescribing issues and polypharmacy are risk factors that have been
shown to increase the likelihood of ADRs [2.3].
In recent years, several tools have been proposed to help prescribers
detect prescribing errors [4-9]. The first explicit criteria were
the Beers criteria (1991) [10], which recommended detecting
potentially inappropriate medications (PIMs). Despite the widespread use
of these criteria throughout the world and the fact that they were
updated in 2015, their implementation in Europe has been limited for
several reasons: they do not consider specific interactions between
drugs, therapeutic duplication, the potential prescribing omissions
(PPOs) of drugs that are indicated, and the fact that more than 50% of
drugs are not available in Europe. In addition, PIM has not been
significantly associated with ADRs in older hospitalized patients
according to the Beers criteria [11].
Therefore, in Europe, it was necessary to develop new criteria according
to the drugs prescribed in this area. The Screening Tool of Older
Persons’ Prescriptions (STOPP)/Screening Tool to Alert to Right
Treatment (START) [12] criteria were finally published in 2008 by
Gallagher et al in Ireland with the objective of detecting potentially
inappropriate prescribing (PIP) and PPOs. The European Geriatrics
Society contributed significantly to the publication of the criteria in
Spain [13] in 2009.
Following the publication of the latest versions of the STOPP-START
criteria14 and the 2015 revision of the Beers criteria
[5,6,10,15], these guidelines are proving to be useful tools, and
research on prescribing issues is growing rapidly. In this sense,
several studies have shown an association between PIP/PPOs and the risk
of ADRs, health-related quality of life, re-hospitalization, and
hospital accident and emergency visits in older community-dwelling
patients [16-20]. Similarly, there is evidence of a significant
improvement in these variables after application of the criteria.
People living with HIV (PLWH) are aging in countries where effective
antiretroviral therapy (ART) is available [21,22], and about 50% of
HIV-infected patients are currently more than 50 years old in developed
countries. Consequently, patients with multiple comorbidities are
becoming more common in daily practice [23]. In fact, the percentage
of persons receiving polypharmacy is high in European HIV-infected
cohorts (14-40%) [24-26]. In this context, PLWH could be at risk of
prescribing issues. However, despite current knowledge, data on this
topic remain scarce, and published data focus mainly on American
populations [27,28]. Therefore, we performed a study to assess the
prevalence of prescribing issues in a Mediterranean cohort of
HIV-infected patients aged ≥65 years.