@article{ace25de7d4ad4b8db3624e7ca5063d82,
title = "Examination of Polypharmacy Trajectories among HIV-Positive and HIV-Negative Men in an Ongoing Longitudinal Cohort from 2004 to 2016",
abstract = "Polypharmacy is the concurrent use of five or more medications. We used group-based trajectory analysis to identify groups of non-HIV medication polypharmacy and investigate associated risk factors among HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study (MACS) from 2004 to 2016. Each participant was assigned to mutually exclusive groups based on their observed patterns of polypharmacy over time. Risk factors associated with membership with resulting groups were investigated using a multinomial generalized logit model with repeated measures. There were 3160 participants (54.3% HIV positive) included in the study. The overall prevalence of polypharmacy was 33.1% and was higher in HIV-positive than HIV-negative participants (36.2% vs. 30.0%; p < 0.001). Four distinct groups of polypharmacy emerged over time among all participants and among HIV-positive participants only: (1) nonpolypharmacy, (2) slow increasing polypharmacy, (3) rapid increasing polypharmacy, and (4) sustained polypharmacy. Being HIV positive, being 50 years of age or older, having medication insurance coverage, and having increased health care use were positively associated with membership in groups with sustained or increasing polypharmacy. Half of participants in each analysis had membership in one of the three high polypharmacy groups. This study revealed that access to care, through medication insurance coverage and health care use, was a key driver of polypharmacy in this cohort. Further exploration of medically appropriate and inappropriate prescribing practices in the context of polypharmacy and its impact on health outcomes in this and other populations is warranted.",
keywords = "HIV/AIDS, MSM, longitudinal cohort, medications, polypharmacy",
author = "Deanna Ware and Palella, {Frank J.} and Chew, {Kara W.} and Friedman, {M. Reuel} and Gypsyamber D'Souza and Ken Ho and Michael Plankey",
note = "Funding Information: The MACS is primarily funded by the National Institute of Allergy and Infectious Diseases, with additional co-funding from the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute of Mental Health. Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute and the National Institute on Deafness and Communication Disorders. MACS data collection is also supported by grant UL1-TR000424 ( Johns Hopkins University Institute for Clinical and Translational Research) from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. This research was supported by the NIH by interagency agreement with the National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and other NIH Cooperative Agreements (U01-HD-32632); and National Institute on Minority Health and Health Disparities (R01-MD010680) [Washington, DC/Baltimore, MD Metropolitan Area: Michael Plankey (co-PI) and M. Reuel Friedman (co-PI)]. Funding Information: Data in this article were collected by the Multicenter AIDS Cohort Study (MACS) with centers at Baltimore (U01-AI35042): The Johns Hopkins University Bloomberg School of Public Health: Joseph B. Margolick [principal investigator (PI)], Todd Brown (PI), Jay Bream, Adrian Dobs, Michelle Estrella, W. David Hardy, Lisette Johnson-Hill, Sean Leng, Anne Monroe, Cynthia Munro, Michael W. Plankey, Wendy Post, Ned Sacktor, Jennifer Schrack, and Chloe Thio; Chicago (U01-AI35039): Feinberg School of Medicine, Northwestern University, and Cook County Bureau of Health Services: Steven M. Wolinsky (PI), Sheila Badri, Dana Gabuzda, Frank J. Palella, Jr., Sudhir Penugonda, John P. Phair, Susheel Reddy, Matthew Stephens, and Linda Teplin; Los Angeles (U01-AI35040): University of California, UCLA Schools of Public Health and Medicine: Roger Detels (PI), Otoniel Mart{\'i}nez-Maza (PI), Otto Yang (co-PI), Peter Anton, Robert Bolan, Elizabeth Breen, Anthony Butch, Shehnaz Hussain, Beth Jamieson, John Oishi, Harry Vinters, Dorothy Wiley, Mallory Witt, Stephen Young, and Zuo Feng Zhang; Pittsburgh (U01-AI35041): University of Pittsburgh, Graduate School of Public Health: Charles R. Rinaldo (PI), Lawrence A. Kingsley (PI), Jeremy J. Martinson (PI), James T. Becker, Phalguni Gupta, Kenneth Ho, Susan Koletar, John W. Mellors, Anthony J. Silvestre, and Ronald D. Stall; Data Coordinating Center (UM1-AI35043): The Johns Hopkins University Bloomberg School of Public Health: Lisa P. Jacobson (PI), Gypsyamber D'Souza (PI), Alison Abraham, Keri Althoff, Michael Collaco, Priya Duggal, Sabina Haberlen, Eithne Keelaghan, Heather McKay, Alvaro Munoz, Derek Ng, Anne Rostich, Eric C. Seaberg, Sol Su, Pamela Surkan, and Nicholas Wada; National Institute of Allergy and Infectious Diseases: Robin E. Huebner; and National Cancer Institute: Geraldina Dominguez. The MACS is primarily funded by the National Institute of Allergy and Infectious Diseases, with additional co-funding from the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute of Mental Health. Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute and the National Institute on Deafness and Communication Disorders. MACS data collection is also supported by grant UL1-TR000424 (JohnsHopkins University Institute for Clinical and Translational Research) from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. This research was supported by the NIH by interagency agreement with the National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute ofChild Health andHumanDevelopment, and otherNIH Cooperative Agreements (U01-HD-32632); and National Institute on Minority Health and Health Disparities (R01-MD010680) [Washington, DC/Baltimore, MD Metropolitan Area:Michael Plankey (co-PI) andM.Reuel Friedman (co-PI)]. Publisher Copyright: {\textcopyright} 2019, Mary Ann Liebert, Inc., publishers.",
year = "2019",
month = aug,
doi = "10.1089/apc.2019.0057",
language = "English (US)",
volume = "33",
pages = "354--365",
journal = "AIDS patient care and STDs",
issn = "1087-2914",
publisher = "Mary Ann Liebert Inc.",
number = "8",
}