Medication burden and prescribing quality in older people living with HIV : Associations with quality of life

OBJECTIVES: To determine the prevalence of polypharmacy, drug-drug interactions (DDIs), potential prescribing omissions (PPOs) and potentially inappropriate medications (PIMs) among people living with Human Immunodeficiency Virus (HIV) aged ≥50 years and to evaluate their association with quality of life. METHODS: This cross-sectional analytical study was conducted between March and May 2025 at a tertiary infectious disease clinic. A total of 141 people living with HIV aged ≥50 years who were receiving antiretroviral therapy (ART) and under active follow-up were included. DDIs were assessed using the Liverpool HIV Drug Interactions database, while PPOs and PIMs were evaluated using the TIME-to-START and TIME-to-STOP criteria. Quality of life was assessed using the PozQoL scale. RESULTS: Polypharmacy was identified in 42 participants (29.8%) and DDIs in 22 (15.6%). Although PPOs were initially identified in all participants according to TIME-to-START criteria, this was largely driven by vaccination-related items. Vaccination-related items were excluded when evaluating the association between PPOs and quality of life, and the prevalence of PPOs decreased to 32.6%. PIMs were detected in 16.3%. Polypharmacy was associated with low quality of life in the health concern domain (OR 3.52, 95% CI 1.34-9.27). DDIs were associated with low overall (OR 7.65, 95% CI 2.01-29.07) and psychological quality of life (OR 14.55, 95% CI 3.45-61.37). PPOs were associated with low psychological (OR 10.67, 95% CI 2.80-40.68) and health concern domains (OR 3.19, 95% CI 1.27-8.05). CONCLUSIONS: Medication-related problems were common among older people living with HIV. Polypharmacy, DDIs and PPOs were associated with impaired quality of life, highlighting the need for structured medication review and multidisciplinary care.