El reto del envejecimiento y la complejidad farmacoterapéutica en el paciente VIH+
Resumen
Objetivo: Describir el conocimiento actual y el manejo del envejecimiento y la complejidad farmacoterapéutica en pacientes VIH ≥ .
Método: Se realizó una revisión bibliográfica, incluyéndose artículos, originales o revisiones, publicados en lengua inglesa o española, desde 2007 al 2017, que analizaron el envejecimiento y la complejidad farmacoterapéutica en pacientes VIH ≥ . Se combinaron los términos: "Polypharmacy”/“Polifarmacia”, “Aging”/“Envejecimiento”, “Frailty”/“Fragilidad”, “Complejidad Farmacoterapéutica”/“Medication Regimen Complexity” y “HIV”/”VIH”. La revisión se realizó de forma independiente por dos autores. Se analizó el grado de concordancia según el índice Kappa.
Resultados: Se analizaron 208 referencias bibliográficas, incluyéndose finalmente 68. Se ha identificado un envejecimiento de la población y un incremento de las comorbilidades asociadas, especialmente a partir de los 50 años. Se han descrito cambios inmunológicos similares a los que se generan en la población anciana no infectada. Esto condiciona, según estudios identificados, la prescripción del tratamiento antirretroviral. Paralelamente, el concepto de polifarmacia está cada vez más presente, definiéndose exclusivamente por el uso concomitante de cinco fármacos. La complejidad farmacoterapéutica, a través del Medication Regimen Complexity Index, se ha empezado a analizar y a relacionar con resultados en salud. Se ha evidenciado una necesidad de profundizar y aplicar conceptos ya conocidos en la población no VIH envejecida, como desprescripción, medicación potencialmente inapropiada, riesgo colinérgico, etc., aunque existen pocos resultados disponibles.
Conclusiones: Existe un interés creciente en profundizar en la relación VIH y envejecimiento. La complejidad farmacoterapéutica está empezando a utilizarse como criterio de seguimiento farmacoterapéutico por su influencia en los resultados en salud. Es necesario manejar e incorporar nuevos conceptos que ayuden a la optimización farmacoterapéutica en esta población.
Palabras clave
Referencias
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DOI: http://dx.doi.org/10.7399%2Ffh.10931
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