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.