Prevalence and global trends of polypharmacy among people living with HIV: a systematic review and meta-analysis

<h3>Background</h3><p dir="ltr">There has been a rising prevalence of polypharmacy among people living with HIV (PLWH). Uncertainty however remains regarding the exact estimates of polypharmacy among these cohorts of patients.</p><h3>Methods</h3><p dir="ltr">We conducted a systematic search of PubMed; EMBASE, CROI, Cochrane Database of Systematic Reviews; Science Citation Index and Database of Abstracts of Reviews of Effects for studies between 1 January 2000 and 30 June 2021 that reported on the prevalence of polypharmacy (ingestion of > 5 non-ART medications) among PLWH on antiretroviral therapy regimen (ART). Prevalence of polypharmacy among HIV-positive patients on ART with Clopper–Pearson 95% confidence intervals were presented. The heterogeneity between studies was evaluated using <i>I</i>^<em>2</em> and <i>τ</i>^<em>2</em> statistics.</p><h3>Results</h3><p dir="ltr">One hundred ninety-seven studies were initially identified, 23 met the inclusion criteria enrolling 55,988 PLWH, of which 76.7% [95% confidence interval (CI): 76.4–77.1] were male. The overall pooled prevalence of polypharmacy among PLWH was 33% (95% CI: 25–42%) (<i>I</i>^<em>2</em> = 100%, τ² = 0.9170, <i>p</i> < 0.0001). Prevalence of polypharmacy is higher in the Americas (44%, 95% CI: 27–63%) (<i>I</i>^<em>2</em> = 100%, τ² = 1.0886, <i>p</i> < 0.01) than Europe (29%, 95% CI: 20–40%) (<i>I</i>^<em>2</em> = 100%, τ² = 0.7944, p < 0.01).</p><h3>Conclusion</h3><p dir="ltr">The pooled prevalence estimates from this synthesis established that polypharmacy is a significant and rising problem among PLWH. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies.</p><p dir="ltr">Registration</p><p dir="ltr"><b>PROSPERO: CRD42020170071</b></p><h2>Other Information</h2><p dir="ltr">Published in: Therapeutic Advances in Drug Safety<br>License: <a href="https://creativecommons.org/licenses/by-nc/4.0/" target="_blank">https://creativecommons.org/licenses/by-nc/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1177/20420986221080795" target="_blank">https://dx.doi.org/10.1177/20420986221080795</a></p>