Anticholinergic medication use in elderly people living with HIV and self-reported neurocognitive impairment: a prospective cohort study. Journal of Antimicrobial Chemotherapy
Jakeman et al. aimed to determine the proportion of patients ≥65 years within the Swiss HIV Cohort Study (SHCS) who receive drugs with anticholinergic (ACH) activity, and evaluated the impact of ACH medication use on self-reported neurocognitive impairment.
Authors performed a literature review to identify commonly used ACH drugs, and scored the ACH burden of each identified medication on a scale between 1 (low activity) and 3 (high activity). In addition, a cross-sectional review of all people living with HIV 65 years or older under active follow-up in the SHCS was performed to estimate the proportion of individuals who receive ACH drugs, and multivariable logistic regression was used to evaluate its impact on patients’ neurocognitive function, which was assessed using three screening questions.
The study included 1918 patients, 85% were male, the median age was 70 years (IQR 67-74) and 91% had HIV RNA <20 copies/mL. Of those individuals aged ≥65 years, 50% received 5 or more non-HIV drugs (polypharmacy). ACH medication use was identified in 200 individuals (20%), and the majority of those drugs had a low ACH activity. Antidepressants were the most commonly prescribed ACH drugs (49%), followed by antipsychotics (7%), benzodiazepines (6%), antihistamines (6%), urinary antispasmodics (5%), opioids (5%) and corticosteroids (5%). Overall, depression showed the strongest association with neurocognitive impairment (aOR 4.60, 95% CI 2.62-80.9). However, in an analysis of individuals without depressive symptoms (n = 911), only the use of drugs with ACH activity (aOR 2.51, 1.31-4.80) and detectable HIV viral load were associated with neurocognitive impairment.
In summary, the present study shows that one out of five elderly people living with HIV in Switzerland receive ACH drugs. Although most of these drugs have a low ACH activity, its use was associated with neurocognitive impairment. These findings indicate that physicians need to be aware that many drugs have ACH activity and their use should be limited in people living with HIV aged 65 years or older. Further studies are needed to assess whether stopping drugs with ACH activity improve neurocognitive function.