A multidisciplinary, <scp>AI</scp> ‐supported quality improvement intervention to manage polypharmacy in aging people with <scp>HIV</scp>

Abstract

OBJECTIVES: Aging people with HIV are increasingly affected by multimorbidity and polypharmacy, which heighten the risk of drug-drug interactions (DDIs) and potentially inappropriate medications (PIMs). This study evaluated a multidisciplinary, AI-supported quality improvement intervention designed to optimize polypharmacy management in older people with HIV. METHODS: People with HIV aged ≥50 years attending the Modena HIV Metabolic Clinic (MHMC) were invited to submit photos of their medications via WhatsApp. Images were processed by AI for optical character recognition and automatically reconciled with the electronic patient chart (EPC). AI recognition accuracy was 94% when validated against manual review. Pharmacists reviewed AI-generated reports from the NavFarma® decision support system, generated alerts for PIM, defined according to Beers and the STOPP/START criteria, DDIs, anticholinergic burden (ACB), and risks of QTc prolongation and nephrotoxicity. Primary outcome was agreement between patient-reported and EPC-recorded medications. Secondary outcomes included pill burden, total prescribed drugs and actionable alerts. RESULTS: Of 181 participants (median age 63 years; 72% male), 111 (61.3%) showed complete agreement between EPC and patient lists, while 70 (38.7%) had discrepancies. Pharmacist evaluation identified major DDIs in 70.4% of cases, ACB in 26.5%, QTc-prolonging drugs in 81.6% and nephrotoxic agents in 95.9%. Participants with ≥10 total prescribed drugs had higher frailty, pill burden and PIM. CONCLUSIONS: AI-assisted medication reconciliation combined with pharmacist review improved the identification of PIM and medication-related risks, supporting safer prescribing in people with HIV. This model aligns with international calls to improve prescribing safety and offers a scalable framework for integrating digital tools into multidisciplinary HIV care.

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