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Background and Importance Anticholinergic burden (AB) in older people living with HIV (PLWHIV) is associated with an increased risk of adverse outcomes.Aim and Objectives The primary objective was to assess AB in a cohort of older PLWHIV using different anticholinergic scales (AS) and to identify factors associated with AB. The secondary objective was to evaluate the level of agreement among AS.Material and Methods A retrospective, cross-sectional, multicentre study was conducted. We included older PLWHIV (≥65 years) who received antiretroviral therapy (ART) from hospital pharmacies of ten Spanish public hospitals between 1 September and 31 December 2021. Demographic, clinical, and pharmacotherapeutic data were obtained from electronic medical records. AB was calculated using the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Risk Scale (ARS), and Anticholinergic Drug Scale (ADS). Agreement between AS was assessed using Cohen’s kappa coefficient. Multivariate analysis was performed to identify factors associated with AB.Results A total of 313 patients were included: 80.5% male, median age of 72 years (IQR 69-76). Median Veterans Ageing Cohort Study (VACS) Index was 39 (IQR 33-46.5). Patients presented a median of 4 non-HIV chronic comorbidities (IQR 3-6) and used a median of 5 non-ART chronic medications (IQR 3-7). Prevalence of any degree AB was 21.7% (n=68) with ACB, 9.9% (n=31) with ARS, and 28.4% (n=89) with ADS. When all three scales were considered simultaneously, AB was identified in 35.1% (n=110) of patients. Agreement between AS was moderate for ACB-ARS and ACB-ADS (k=0.404, p<0.001; k=0.586, p<0.001, respectively), and poor for ARS-ADS (k=0.199, p<0.001). Factors associated with AB included older age (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.07-1.20), higher number of non-ART chronic medications (OR 1.36, 95% CI 1.23-1.50), female sex (OR 2.38, 95% CI 1.14-4.97), and presence of neuropsychiatric disorders (OR 7.37, 95% CI 3.90-13.94).Conclusion and Relevance A substantial proportion of older PLWHIV presented with AB, although prevalence estimates varied depending on the AS used. Factors associated with increased AB highlight patient groups in whom targeted medication review is particularly warranted. Given the limited agreement among AS, screenings for AB in PLWHIV should prefer the simultaneous use of different AS, as the choice of scale may influence the identification of at risk patients.Conflict of Interest No conflict of interest