Use of different anticholinergic scales and their correlation with anticholinergic symptom burden in a cohort of people living with HIV

Author:

Mazzitelli Maria1ORCID,Trunfio Mattia23,Coin Alessandra4,Sasset Lolita1,Farina Jacopo4,Brundu Monica1,Scaglione Vincenzo1,Devita Maria5ORCID,Sergi Giuseppe4,Cattelan Anna M16

Affiliation:

1. Infectious and Tropical Diseases Unit, Padua University Hospital , 35128 Padua , Italy

2. Infectious Diseases Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital , 10149 Turin , Italy

3. HIV Neurobehavioral Research Program and Departments of Neurosciences and Psychiatry, School of Medicine, University of California , San Diego, CA , USA

4. Geriatric Unit, Padua University Hospital , 35128 Padua , Italy

5. General Psychology Department, Padua University , 35131 Padua , Italy

6. Department of Molecular Medicine, Padua University , 35128 Padua , Italy

Abstract

Abstract Objectives How to detect the clinical impact of anticholinergic (AC) burden in people with HIV (PWH) remains poorly investigated. We cross-sectionally described the prevalence and type of AC signs/symptoms and the screening accuracy of three AC scales in detecting their presence in a modern cohort of PWH. Methods We calculated AC Burden Scale (ABS), AC Risk Score (ARS) and AC Drug Score (ADS) in 721 adult PWH and recorded the presence of AC signs/symptoms over the previous 3 months. High AC risk was defined by ABS score ≥2, and ARS or ADS score ≥3. Comparisons among the scale were based on Cohen’s inter-rater agreement, and their screening accuracy was assessed by receiver operating characteristics (ROC) curves and performance measures. Results We enrolled 721 PWH, of whom 72.0% of participants were male; the median age was 53 years, and 164 participants (22.7%) were on at least one AC drug. Among these, 28.6% experienced at least one AC sign/symptom. Agreement in AC risk classification was substantial only between ARS and ADS (k = 0.6). Lower and higher risk of AC signs/symptoms was associated with dual regimens [adjusted OR (aOR) = 0.12 versus three-drug regimens, P = 0.002] and increasing number of AC drugs (aOR = 12.91, P < 0.001). Depression and COPD were also associated with higher risk of AC signs/symptoms in analysis unadjusted for number of AC drugs. ABS and ADS showed the best area under the ROC curve (AUROC) of 0.85 (0.78–0.92) and 0.84 (0.75–0.92; P < 0.001 for both). However, at the cut-off used for the general population, the sensitivity of all three scales was very low (34.0%, 46.8% and 46.8%). Conclusions Up to one-fourth of participants in our cohort were exposed to at least one AC drug, and among them AC signs/symptoms affected more than one-fourth. Both polypharmacy (as number of antiretrovirals and of co-medications with AC properties) and to a lesser extent specific comorbidities shaped the risk of developing AC signs/symptoms. Sensitive screenings for AC risk in PWH should prefer ABS or ADS based on lower cut-offs than those suggested for the general population.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Pharmacology (medical),Pharmacology,Microbiology (medical)

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