老年HIV/AIDS多病共存患者多重用药管理的研究进展

摘要/Abstract

摘要：

长期人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染和抗逆转录病毒治疗（antiretroviral therapy，ART）造成了HIV感染者非艾滋病相关合并症（non AIDS defining diseases，NADs）患病风险持续增高，随之而来的多重用药现象也极大增加了患者的用药负担，严重影响HIV感染者/艾滋病（acquired immune deficiency syndrome，AIDS）患者的药物自我管理和安全用药。本文系统回顾了老年HIV/AIDS多病共存患者多重用药的概念、评估工具、影响因素，并提出老年HIV/AIDS多病共存患者多重用药的管理策略，以期为HIV感染者合并NADs多重用药管理的研究和护理实践提供参考。

关键词: 人类免疫缺陷病毒, 老年人, 多病共存, 多重用药, 影响因素, 综述

Abstract:

Long-term human immunodeficiency virus（HIV） infection and antiretroviral therapy（ART） have led to an increasing risk of non-acquired immune deficiency syndrome（AIDS）-related complications（NADs） in HIV-infected patients. The resulting polypharmacy has also greatly increased the drug burden of patients，seriously affecting the drug self-management and safe medication of HIV/AIDS patients. This paper systematically reviews the concept，evaluation tools and influencing factors of polypharmacy in elderly HIV/AIDS patients with multimorbidity，and puts forward the management strategies of polypharmacy in elderly HIV/AIDS patients with multimorbidity，in order to provide reference for the research and nursing practice of polypharmacy management in HIV-infected patients with NADs.

Key words: HIV, Elderly, Multimorbidity, Polypharmacy, Influencing factors, Review

中图分类号:

R512.91

谢传艺, 汪皖莲, 胡亚丽, 晏定燕, 赵柏青, 李儿. 老年HIV/AIDS多病共存患者多重用药管理的研究进展. [J]职业与健康, 2026, 42(21): 3003-3008.

XIE Chuanyi, WANG Wanlian, HU Yali, YAN Dingyan, ZHAO Baiqing, LI Er. Research progress on polypharmacy management in elderly HIV/AIDS patients with multimorbidity. [J]OCCUPATION AND HEALTH, 2026, 42(21): 3003-3008.

参考文献 48

[1]	Joint United Nations Programme on HIV/AIDS(UNAIDS). UNAIDS DATA 2023[EB/OL]. (2024-12-02)[2025-03-27]. https://www.unaids.org/en/resou-rces/fact-sheet.
[2]	TRICKEY A, SABIN C A, BURKHOLDER G, et al. Life expectancy after 2015 of adults with HIV on Long-term antiretroviral therapy in Europe and North America:A collaborative analysis of cohort studies[J]. Lancet HIV, 2023, 10(5):e295-e307.
[3]	KIM J, NAM H J, KIM J Y, et al. Aging with HIV:The burden of comorbi-dities,polypharmacy,and drug interactions in Korean people living with HIV aged ≥50 years[J]. Infect Chemother, 2024, 56(4):534-543.
[4]	DUAN Y, ZHAO H, TANG W, et al. Longitudinal analysis of new-onset non-AIDS-defining diseases among people living with HIV:A real-world observational study[J]. HIV Med, 2022,Suppl(1):32-41.
[5]	何加敏, 朱政, 卢洪洲. HIV感染者合并慢性非传染性疾病多药依从性管理的研究进展[J]. 中华护理杂志, 2022, 57(14):1788-1793.
[6]	DA SILVA R P N, MARINS L M S, GUARALDO L, et al. Pharmacotherapeutic profile, polypharmacy and its associated factors in a cohort of people living with HIV in Brazil[J]. AIDS Res Ther, 2023, 20(1):57.
[7]	MOHAMMED M A, MOLES R J, CHEN T F. Medication-related burden and patients' lived experience with medicine:A systematic review and meta-synthesis of qualitative studies[J]. BMJ Open, 2016, 6(2):e010035.
[8]	唐天娇, 曹立, 董碧蓉, 等. 老年人多病共存名词和定义专家共识(2022)[J]. 中华老年医学杂志, 2022, 41(9):1028-1031.
[9]	DANJUMA M I, KHAN S, WAHBEH F, et al. What is polypharmacy in people living with HIV/AIDSA systematic review[J]. AIDS Res Ther, 2022, 19(1):37.
[10]	American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice:Core elements of an MTM service model(version 2.0)[J]. J Am Pharm Assoc(2003), 2008,48(3):341-353.
[11]	MANIAS E, BEANLAND C J, RILEY R G, et al. Development and validation of the self-administration of medication tool[J]. Ann Pharmacother, 2006, 40(6):1064-1073.
[12]	LIN B, MEI Y, MA F, et al. Testing the validity and reliability of the Self-Administration of Medication(SAM) instrument in Chinese chronic disease patients:A cross-cultural adaptation[J]. Int J Nurs Pract, 2018, 24(2):e12625.
[13]	PATTON D E, WOODS S P, FRANKLIN D J R, et al. Relationship of medication management test-revised(MMT-R) performance to neuropsychological functioning and antiretroviral adherence in adults with HIV[J]. AIDS Behav, 2012, 16(8):2286-2296.
[14]	KNOBEL H, ALONSO J, CASADO J L, et al. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients:The GEEMA Study[J]. AIDS, 2002, 16(4):605-613.
[15]	黄洁, 郝桂华, 陈章, 等. 维持性血液透析患者口服磷结合剂依从性问卷的汉化及信效度研究[J]. 中华现代护理杂志, 2017, 23(24):3098-3102.
[16]	HE D, ZHU H, ZHOU H, et al. Potentially inappropriate medications in Chinese older adults:A comparison of two updated Beers criteria[J]. Int J Clin Pharm, 2021, 43(1):229-235.
[17]	朱素燕, 郑晓梦, 范苗, 等. 《老年人潜在不适当处方筛查工具/处方遗漏筛查工具(STOPP/START)标准》第3版解读[J]. 中国全科医学, 2024, 27(33):4097-4104.
[18]	中国老年保健医学研究会老年合理用药分会, 中华医学会老年医学分会, 中国药学会老年药学专业委员会, 等. 中国老年人潜在不适当用药判断标准(2017年版)[J]. 药物不良反应杂志, 2018, 20(1):2-8.
[19]	汤昀玥. 智能药盒与微信联用对在治HIV阳性MSM服药依从性及生命质量影响的研究[D]. 衡阳: 南华大学, 2022.
[20]	SANGEDA R Z, MOSHA F, PROSPERI M, et al. Pharmacy refill adherence outperforms self-reported methods in predicting HIV therapy outcome in resource-limited settings[J]. BMC Public Health, 2014, 14:1035.
[21]	殷韵, 申鹏悦, 钟世勇, 等. 四川省凉山州HIV/AIDS患者抗病毒治疗服药依从性及其影响因素[J]. 中国艾滋病性病, 2021, 27(1):17-20.
[22]	KALICHMAN S C, PELLOWSKI J, KEGLER C, et al. Medication adherence in people dually treated for HIV infection and mental health conditions:Test of the medications beliefs framework[J]. J Behav Med, 2015, 38(4):632-641.
[23]	ARERI H, MARSHALL A, HARVEY G. Exploring self-Management of adults living with HIV on antiretroviral therapy in North-West Ethiopia:Qualitative study[J]. HIV AIDS(Auckl), 2020, 12:809-820.
[24]	EDELMAN E J, RENTSCH C T, JUSTICE A C. Polypharmacy in HIV:recent insights and future directions[J]. Curr Opin HIV AIDS, 2020, 15(2):126-133.
[25]	CLABORN K R, MEIER E, MILLER M B, et al. A systematic review of treatment fatigue among HIV-infected patients prescribed antiretroviral therapy[J]. Psychol Health Med, 2015, 20(3):255-265.
[26]	LIU B, YANG Y, ZHOU H, et al. Prevalence and associated factors of treatment regimen fatigue among people living with HIV/AIDS in China:A cross-sectional survey[J]. Patient Prefer Adherence, 2025, 19:583-591.
[27]	WANG X, XU H, ZHANG Y, et al. Exploring the relationship between illness perception,self-management and quality of life among HIV-positive men who have sex with men[J]. J Adv Nurs, 2024, 80(12):4963-4973.
[28]	MENDENHALL E, BOSIRE E N, KIM A W, et al., Cancer,chemotherapy,and HIV:Living with cancer amidst comorbidity in a South African township[J]. Soc Sci Med, 2019, 237:112461.
[29]	ZELEKE T A, ALEMU K, AYELE T A, et al. Systematic review and meta-analysis on the effect of depression on ART adherence among women living with HIV[J]. PLoS One, 2024, 19(6):e0300106.
[30]	UNAIDS. Reduction of HIV-related stigma and discrimination:guidance not[EB/OL]. (2019-09-28)[2025-11-26]. https://www.unaids.org/sites/default/files/media_asset/2014unaidsguidancenote_stigma_en.pdf.
[31]	YANG Z, ZHU Z, LIZARONDO L, et al. Experience of chronic noncommunicable disease in people living with HIV:A systematic review and meta-aggregation of qualitative studies[J]. BMC Public Health, 2021, 21(1):1651.
[32]	BEVILACQUA K G, BRINKLEY C, MCGOWAN J, et al. "We are getting those old people things." polypharmacy management and medication adherence among adult hiv patients with multiple comorbidities:A qualitative study[J]. Patient Prefer Adherence, 2022, 16:2773-2780.
[33]	余静, 谢幸尔, 钱湘云, 等. 艾滋病患者积极应对疾病的真实体验研究[J]. 中华护理杂志, 2021, 56(3):399-403.
[34]	HE J, ZHU Z, SUN M, et al. Barriers and facilitators to maintaining a high level of polypharmacy adherence in people living with HIV:A scoping review[J]. Front Pharmacol, 2023, 14:1013688.
[35]	VAN POELGEEST E, SEPPALAL , BAHAT G, et al. Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy:EuGMS SIG on pharmacology position paper[J]. Eur Geriatr Med, 2023, 14(6):1195-1209.
[36]	ONDER G, VETRANO D L, PALMER K, et al. Italian guidelines on management of persons with multimorbidity and polypharmacy[J]. Aging Clin Exp Res, 2022, 34(5):989-996.
[37]	沈杰, 高宁舟, 郑松柏, 等. 老年人多重用药评估与管理中国专家共识(2024)[J]. 中华老年医学杂志, 2024, 43(3):269-278.
[38]	PENM J, VAILLANCOURT R, POULIOT A. Defining and identifying concepts of medication reconciliation:An international pharmacy perspective[J]. Res Social Adm Pharm, 2019, 15(6):632-640.
[39]	PAYNE R A, BLAIR P S, CADDICK B, et al. Optimising polypharmacy management in primary care through general practitioner-pharmacist collaboration,informatics,and enhancing clinician engagement:The IMPPP cluster-randomised trial[J]. Lancet Healthy Longev, 2025, 6(10):100774.
[40]	徐园园, 徐志杰, 倪雅婷, 等. 社区老年人处方精简的研究进展与启示[J]. 中国全科医学, 2022, 25(13):1557-1563.
[41]	MORILLO-VERDUGO R, SOLIS-MARTIN C, MARQUEZ-SAAVEDRA E, et al. Implementation and evaluation of a real-time prescription alert system to optimize antiretroviral therapy and medication adherence in people living with HIV sanpat project[J]. Patient Prefer Adherence, 2025, 19:3493-3508.
[42]	刘炜彬, 程淑华, 蒋楠. 人工智能技术在老年慢性病病人药物管理中应用的研究进展[J]. 护理研究, 2025, 39(7):1206-1210.
[43]	World Health Organization(WHO). WHO guideline on HIV service delivery[EB/OL]. (2025-09-01)[2025-11-26]. https://www.who.int/publications/i/item/9789240113879.
[44]	European AIDS Clinical Society(EACS). European AIDS Clinical Society guidelines 2025[EB/OL]. (2025-10-15)[2025-11-26]. https://www.eacsociety.org/guidelines/eacs-guidelines/.
[45]	KRAEF C, SINGH S, FURSA O, et al. Differences in integrated assessment and management of non-communicable diseases(NCDs) for people with HIV across the WHO European region[J]. HIV Med, 2024, 25(6):700-710.
[46]	MATANJE MWAGOMBA B L, AMEH S, BONGOMIN P, et al. Opportunities and challenges for evidence-informed HIV-noncommunicable disease integrated care policies and programs:Lessons from Malawi,South Africa,Swaziland and Kenya[J]. AIDS, 2018, 32(Suppl1):S21-S32.
[47]	沈银忠. 中国艾滋病诊疗指南(2024版)[J]. 中国艾滋病性病, 2024, 30(8):779-806.
[48]	黄鹏, 魏丽荣, 徐博宁. HIV感染者全生命周期管理模式的建立[J]. 中国卫生标准管理, 2022, 13(7):28-31.