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Palfai TP, Winter MR, Magane KM, Heeren TC, Bernier LB, Murray GE, Saitz R, Kim TW, Stein MD. Pain and unhealthy alcohol use among people living with HIV: A prospective cohort study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39317678 DOI: 10.1111/acer.15447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 08/03/2024] [Accepted: 08/31/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Unhealthy alcohol use is prevalent among people living with HIV/AIDS (PLWH) and contributes to impaired functioning, diminished quality of life, and poorer HIV outcomes. Common cooccurring conditions such as chronic pain may be associated with negative outcomes both directly and through its influence on unhealthy drinking itself. However, there is relatively little known about how pain influences unhealthy drinking among PLWH over time. The current study examined whether pain was associated with indices of unhealthy alcohol use, namely heavy drinking and alcohol use disorder (AUD) assessed 12 months later. METHODS The study sample (n = 207) was from the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) Cohort, a prospective cohort of PLWH with a history of illicit substance or unhealthy alcohol use. We conducted logistic regression analyses to examine the associations between pain and both heavy drinking and AUD status (DSM-5 criteria) (yes/no) over time. In secondary analyses, we examined whether pain was associated with greater AUD severity and whether pain interference was associated with heavy drinking and AUD outcomes. RESULTS We found that pain at baseline was associated with greater odds of AUD [aOR = 2.29 (95% CI: 1.13, 4.64), p = 0.02] but not heavy drinking [aOR = 0.91 (95% CI: 0.44, 1.88), p = 0.79] at 12 months. Pain was also associated with more severe AUD. Analyses of pain interference showed similar results. CONCLUSIONS Pain is prospectively associated with higher odds of AUD among PLWH with a substance/unhealthy alcohol use history. Providers should routinely address pain among PLWH to improve AUD outcomes.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Michael R Winter
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kara M Magane
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren B Bernier
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Grace E Murray
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Theresa W Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Michael D Stein
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Masters MC, Campbell LM, Yu J, Heaton A, Erlandson KM, Garudadri H, Nguyen T, Moore DJ, Moore RC. Postural Stability as a Measure of Fall Risk in Older People with and without HIV. AIDS Res Hum Retroviruses 2024. [PMID: 38973466 DOI: 10.1089/aid.2024.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
As the number of older people with HIV (PWH) grows, accidental falls and their associated negative health outcomes are of increasing concern. Fall risk can be measured using novel screening tools such as evaluating postural stability using force plate technology. The aims of this study were to test this technology to assess fall risk among older PWH. In a cross-sectional, observational study of people without HIV (PWoH) with a range of fall risk, participants underwent balance assessment using the validated BTrackS balance plate. Postural stability was compared by HIV serostatus. Multivariable linear regressions were used to examine the relationship between postural stability and validated measures of fall risk balance and frailty status. Among 34 PWH and 30 PWoH, all ≥50 years, postural stability was worse among PWH (35.4 cm vs. 28.3 cm, p = .07). In multivariable models, worse postural stability was associated with reporting a fall in the past 6 months (β = 0.32, p = .004), worse fall efficacy (β = 0.45, p < .001), and being frail or prefrail (β = 0.26, p = .027). In multivariable models stratified by HIV serostatus, worse postural stability was significantly associated with worse fall efficacy (β = 0.53, p < .01) and lower balance confidence (β = -0.33, p =. 04) among PWH but not PWoH. Among older PWH and PWoH, worse postural stability was associated with validated measures of fall risk, including history of falls and poorer fall efficacy. Assessment of postural sway is a promising objective screening test for fall risk among older PWH.
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Affiliation(s)
- Mary Clare Masters
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura M Campbell
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Jimmy Yu
- University of California San Diego Medical School, La Jolla, California, USA
| | - Anne Heaton
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | | | - Hari Garudadri
- Department of Electrical and Computer Engineering, University of California San Diego, San Diego, California, USA
| | - Truong Nguyen
- Department of Electrical and Computer Engineering, University of California San Diego, San Diego, California, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
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Batterham RL, Bedimo RJ, Diaz RS, Guaraldi G, Lo J, Martínez E, McComsey GA, Milinkovic A, Naito T, Noe S, O'Shea D, Paredes R, Schapiro JM, Sulkowski MS, Venter F, Waters L, Yoruk IU, Young B. Cardiometabolic health in people with HIV: expert consensus review. J Antimicrob Chemother 2024; 79:1218-1233. [PMID: 38656584 PMCID: PMC11144490 DOI: 10.1093/jac/dkae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To develop consensus data statements and clinical recommendations to provide guidance for improving cardiometabolic health outcomes in people with HIV based on the knowledge and experience of an international panel of experts. METHODS A targeted literature review including 281 conference presentations, peer-reviewed articles, and background references on cardiometabolic health in adults with HIV published between January 2016 and April 2022 was conducted and used to develop draft consensus data statements. Using a modified Delphi method, an international panel of 16 experts convened in workshops and completed surveys to refine consensus data statements and generate clinical recommendations. RESULTS Overall, 10 data statements, five data gaps and 14 clinical recommendations achieved consensus. In the data statements, the panel describes increased risk of cardiometabolic health concerns in people with HIV compared with the general population, known risk factors, and the potential impact of antiretroviral therapy. The panel also identified data gaps to inform future research in people with HIV. Finally, in the clinical recommendations, the panel emphasizes the need for a holistic approach to comprehensive care that includes regular assessment of cardiometabolic health, access to cardiometabolic health services, counselling on potential changes in weight after initiating or switching antiretroviral therapy and encouraging a healthy lifestyle to lower cardiometabolic health risk. CONCLUSIONS On the basis of available data and expert consensus, an international panel developed clinical recommendations to address the increased risk of cardiometabolic disorders in people with HIV to ensure appropriate cardiometabolic health management for this population.
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Affiliation(s)
- Rachel L Batterham
- UCL Division of Medicine, UCL School of Life and Medical Sciences, University College London, Gower Street, London WC1E 6BT, UK
- University College London Hospitals Biomedical Research Centre, National Institute for Health and Care Research, Maple House Suite A 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Roger J Bedimo
- Infectious Disease Section, VA North Texas Health Care System, 4500 S Lancaster Road, Dallas, TX 75216, USA
- Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Ricardo S Diaz
- Infectious Diseases Department, Paulista School of Medicine, Federal University of São Paulo, R. Sena Madureira, 1500 Vila Clementino, São Paulo, 04021-001, Brazil
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Via Università 4, 41121 Modena, Italy
| | - Janet Lo
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Esteban Martínez
- Infectious Diseases Unit, Hospital Clinic and University of Barcelona, C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Grace A McComsey
- Case Center for Diabetes, Obesity and Metabolism, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Ana Milinkovic
- Global Medical, ViiV Healthcare, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
- HIV Services, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
- Imperial College London, Exhibition Road, South Kensington, London SW7 2BX, UK
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan
| | - Sebastian Noe
- MVZ Karlsplatz, MVZ Karlsplatz 8, 80335, Munich, Germany
| | - Donal O'Shea
- Health Sciences Centre, University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
| | - Roger Paredes
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Jonathan M Schapiro
- National Hemophilia Center, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Tel Aviv, Israel
| | - Mark S Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - François Venter
- Ezintsha, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa
| | - Laura Waters
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, 350 Euston Road, Regent's Place, London NW1 3AX, UK
| | - Ilksen Ungan Yoruk
- General Medicines Europe, GSK, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Benjamin Young
- Global Medical, ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA
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Gill SV, Shin D, Kim TW, Magane KM, Hereen T, Winter M, Helfrich C, Saitz R. A Fall Prevention Feasibility Trial for People With HIV and Alcohol Use. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241238956. [PMID: 38554013 DOI: 10.1177/15394492241238956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Alcohol contributes to higher fall risk in people living with HIV (PLWH), yet fall prevention trials for PWH with alcohol use are lacking. To assess the feasibility of conducting a randomized controlled trial of a 10-week online fall prevention intervention tailored for PLWH with alcohol use. The intervention consisted of weekly virtual group discussions, individual phone check-ins, and home exercises. Of those eligible, 53.5% (23/43) enrolled (12 to the intervention and 11 to control). Mean age was 58 years; 82.6% had a past 6-month fall; 65.2% had alcohol use disorder; and 95.7% completed postintervention assessments. The intervention was highly rated (Client Satisfaction Questionnaire-8 score M = 30.4, SD = 1.6) with a wide range of group and individual phone session attendance. Preliminary analyses suggest the intervention may reduce the odds of falling and alcohol use frequency. Findings support the feasibility of a larger randomized trial. ClinicalTrials.gov Identifier: NCT04804579.
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Bertholet N, Saitz R, Hahn JA, Heeren TC, Emenyonu NI, Freiberg M, Winter MR, Kim TW, Magane K, Lloyd-Travaglini C, Fatch R, Bryant K, Forman LS, Rateau L, Blokhina E, Muyindike WR, Gnatienko N, Samet JH. Impact of alcohol use disorder severity on human immunodeficiency virus (HIV) viral suppression and CD4 count in three international cohorts of people with HIV. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:704-712. [PMID: 36799302 PMCID: PMC10198460 DOI: 10.1111/acer.15031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/02/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Alcohol use has been linked to worse human immunodeficiency virus (HIV) immunologic/virologic outcomes, yet few studies have explored the effects of alcohol use disorder (AUD). This study assessed whether AUD severity is associated with HIV viral suppression and CD4 count in the three cohorts of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium. METHODS People with HIV (PWH) in Uganda (n = 301), Russia (n = 400), and Boston (n = 251), selected in-part based on their alcohol use, were included in analyses. Logistic and linear regressions were used to assess the cross-sectional associations between AUD severity (number of DSM-5 diagnostic criteria) and (1) HIV viral suppression, and (2) CD4 count (cells/mm3 ) adjusting for covariates. Analyses were conducted separately by site. RESULTS The proportion of females was 51% (Uganda), 34% (Russia), and 33% (Boston); mean age (SD) was 40.7 (9.6), 38.6 (6.3), and 52.1 (10.5), respectively. All participants in Uganda and all but 27% in Russia and 5% in Boston were on antiretroviral therapy. In Uganda, 32% met criteria for AUD, 92% in Russia, and 43% in Boston. The mean (SD) number of AUD criteria was 1.6 (2.4) in Uganda, 5.6 (3.3) in Russia, and 2.4 (3.1) in Boston. Most participants had HIV viral suppression (Uganda 92%, Russia 57%, Boston 87%); median (IQR) CD4 count was 673 (506, 866), 351 (201, 542), and 591 (387, 881), respectively. In adjusted models, there were no associations between AUD severity and HIV viral suppression: adjusted odds ratios (AOR) (95%CI) per 1 additional AUD criterion in Uganda was 1.08 (0.87, 1.33); Russia 0.98 (0.92, 1.04); and Boston 0.95 (0.84, 1.08) or CD4 count: mean difference (95%CI) per 1 additional criterion: 5.78 (-7.47, 19.03), -3.23 (-10.91, 4.44), and -8.18 (-24.72, 8.35), respectively. CONCLUSIONS In three cohorts of PWH, AUD severity was not associated with HIV viral suppression or CD4 count. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control.
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Affiliation(s)
- Nicolas Bertholet
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Richard Saitz
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith A. Hahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Nneka I. Emenyonu
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Freiberg
- Vanderbilt Center for Clinical Cardiovascular Trials Evaluation (V-C3REATE), Vanderbilt University Medical Center, Cardiovascular Division, Nashville, TN, USA
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Theresa W. Kim
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
| | - Kara Magane
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Christine Lloyd-Travaglini
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Leah S. Forman
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Lindsey Rateau
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Elena Blokhina
- First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Winnie R. Muyindike
- Mbarara University of Science and Technology Department of Internal Medicine, Mbarara, Uganda
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
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Shin D, Gill SV, Kim TW, Magane KM, Mason T, Heeren T, Winter M, Helfrich C, Saitz R. Study Protocol for a Pilot Randomized Trial of a Virtual Occupational Therapy Fall Prevention Intervention for People With HIV and Alcohol Use. Subst Abuse 2022; 16:11782218221145548. [PMID: 36578450 PMCID: PMC9791282 DOI: 10.1177/11782218221145548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Background People living with HIV (PLWH) are at risk for falls due to polypharmacy, unhealthy substance (risky alcohol and/or illicit drug) use, low physical activity, and frailty combined with typical age-related physical changes. Fall prevention is needed to reduce the morbidity related to falls and fractures, however, there is a paucity of data on the design of a fall prevention intervention and whether it can be delivered virtually. We describe the protocol of a pilot randomized trial of a virtual occupational therapy fall prevention intervention for people with HIV at high risk for falls and recent alcohol and/or drug use. Method PLWH will be recruited from the Boston ARCH 4F Cohort study, an observational study of PLWH to examine the impact of alcohol on falls. Trial participants will be randomized to either an occupational therapy-led fall prevention intervention or provided with written education about fall prevention and alcohol use (control). The 10-week fall prevention intervention was based upon results from qualitative interviews with PLWH about falls and will consist of weekly virtual group sessions, home exercises and phone-check-ins, delivered by occupational therapists. The primary outcome measures will be number of groups attended and a participant-completed satisfaction survey. Change in number of falls, alcohol and other drug use, and physical functioning will be examined. Discussion A virtual occupational therapy fall prevention intervention addresses the emerging concern of fall risk in PLWH and alcohol use. This pilot study will provide preliminary estimates of fall-related outcomes as well as feasibility of study procedures for a larger trial. ClinicalTrialsgov Identifier NCT04804579. Boston University Protocol Record H-41041.
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Affiliation(s)
- Danny Shin
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Simone V Gill
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Theresa W Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Kara M Magane
- Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA
| | - Tiana Mason
- Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School Public Health, Boston, MA, USA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School Public Health, Boston, MA, USA
| | - Christine Helfrich
- School of Health Sciences, American International College, Springfield, MA, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA
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Kim TW, Samet JH, Lodi S, Kimmel SD, Forman LS, Lira MC, Liebschutz JM, Williams EC, Walley AY. Functional Impairment and Cognitive Symptoms Among People with HIV Infection on Chronic Opioid Therapy for Pain: The Impact of Gabapentin and Other Sedating Medications. AIDS Behav 2022; 26:3889-3896. [PMID: 35737281 PMCID: PMC11055610 DOI: 10.1007/s10461-022-03716-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/01/2022]
Abstract
Gabapentin is associated with dizziness, falls, and somnolence yet commonly prescribed to people with HIV (PWH) treated with chronic opioid therapy (COT). Physical function and cognition are understudied when prescribed together. Among PWH on COT, we evaluated whether co-prescribed gabapentin is associated with (a) functional impairment; (b) trouble thinking clearly; and (c) difficulty controlling drowsiness using logistic regression models adjusted for prescribed opioid dose, other (non-gabapentin) sedating medication, substance use disorder, and mental/physical health indicators in a cross-sectional study. Among 166 participants, 40% were prescribed gabapentin, 41% reported functional impairment, 41% trouble thinking clearly, and 38% difficulty controlling drowsiness. Gabapentin co-prescribed with COT was significantly associated with trouble thinking clearly but not with functional impairment or difficulty controlling drowsiness. Clinicians should be cognizant of potential problems with thinking clearly when co-prescribing gabapentin and opioid medication.
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Affiliation(s)
- Theresa W Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
| | - Jeffrey H Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Simeon D Kimmel
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Leah S Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, USA
| | - Marlene C Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Department of Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Emily C Williams
- Department of Health Services, University of Washington, Seattle, WA, USA
- Veterans Health Administration Health Services Research and Development, Center of Innovation for Veteran-Centered Value-Drive Care, Seattle, WA, USA
| | - Alexander Y Walley
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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8
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Kim TW, Heeren TC, Samet JH, Bertholet N, Lloyd-Travaglini C, Winter MR, Magane KM, Gnatienko N, Bryant K, Rateau LJ, Muyindike WR, Hahn JA, Blokhina E, Saitz R. Alcohol and falls among people with HIV infection: A view from Russia and the United States. Alcohol Clin Exp Res 2022; 46:1742-1752. [PMID: 35957545 PMCID: PMC9509482 DOI: 10.1111/acer.14915] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Both human immunodeficiency virus (HIV) infection and alcohol use predispose to autonomic/sensory neuropathy, imbalance symptoms, and cognitive impairment-conditions associated with a greater risk of falls-yet it is unclear how to identify people with HIV (PWH) whose drinking is associated with falls. Research on alcohol and falls using the same instruments in different countries could help to specify the level of alcohol use associated with fall risk. We examined whether a consumption-based measure (the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) and/or a symptom-based measure (DSM-5 criteria for alcohol use disorder [AUD]) are associated with sustaining a fall among PWH in St Petersburg, Russia and Boston, Massachusetts in the United States. METHODS Separate multivariate logistic regressions were used for each cohort to examine cross-sectional associations for each alcohol measure predicting fall. Potential confounders included physical functioning, depressive symptoms, and other substance use (measured with the Addiction Severity Index). RESULTS A fall was reported by 35% (87/251) of the sample in Boston and 12% (46/400) in St Petersburg. Each additional AUD criterion-but not higher AUDIT-C score-was significantly associated with a fall in both Boston (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.02, 1.18) and St Petersburg (adjusted OR AOR = 1.10; 95% CI 1.02, 1.18). Heavy alcohol use (>6 drinks/occasion, any vs. none) was associated with more than twice the odds of a fall (AOR = 2.24; 95% CI 1.21, 4.13) in Boston. CONCLUSIONS These findings suggest that while fall risk may vary by setting and population, heavy alcohol use and AUD symptom severity are potential targets for interventions to prevent falls. Studies in diverse global settings advance our understanding of the relationship between alcohol and falls in PWH.
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Affiliation(s)
- Theresa W Kim
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA (TWK, JHS, NG, RS)
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA (TCH)
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA (TWK, JHS, NG, RS)
| | - Nicolas Bertholet
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (NB)
| | - Christine Lloyd-Travaglini
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA (CLT, MRW, LJR)
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA (CLT, MRW, LJR)
| | - Kara M. Magane
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA (JHS, KM, RS)
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA (TWK, JHS, NG, RS)
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland, USA
| | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA (CLT, MRW, LJR)
| | - Winnie R Muyindike
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda (WRM)
| | - Judith A Hahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA (JAH)
| | - Elena Blokhina
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation (EB)
| | - Richard Saitz
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA (TWK, JHS, NG, RS)
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA (TCH)
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9
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Psomas CK, Hoover DR, Shi Q, Brown TT, Vance DE, Holman S, Plankey MW, Tien PC, Weber KM, Floris-Moore M, Bolivar HH, Golub ET, McDonnell Holstad M, Radtke KK, Tamraz B, Erlandson KM, Rubin LH, Sharma A. Polypharmacy Is Associated With Falls in Women With and Without HIV. J Acquir Immune Defic Syndr 2022; 90:351-359. [PMID: 35333216 PMCID: PMC9203977 DOI: 10.1097/qai.0000000000002955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aging in people with HIV is associated with increased risk of developing synergistic conditions such as neurocognitive impairment, polypharmacy, and falls. We assessed associations between polypharmacy (use of 5 or more non-ART medications), use of neurocognitive adverse effects (NCAE) medications, and odds of falls in women with HIV (WWH) and without HIV (HIV-). METHODS Self-reported falls and medication use data were contributed semiannually by 1872 (1315 WWH and 557 HIV-) Women's Interagency HIV Study participants between 2014 and 2016. Polypharmacy and NCAE medication use were evaluated separately and jointly in multivariable models to assess their independent contributions to single and multiple falls risk. RESULTS The proportion of women who reported any fall was similar by HIV status (19%). WWH reported both greater polypharmacy (51% vs. 41%; P < 0.001) and NCAE medication use (44% vs. 37%; P = 0.01) than HIV- women. Polypharmacy conferred elevated odds of single fall [adjusted odds ratio (aOR) 1.67, 95% CI: 1.36 to 2.06; P < 0.001] and multiple falls (aOR 2.31, 95% CI: 1.83 to 2.93; P < 0.001); the results for NCAE medications and falls were similar. Both polypharmacy and number of NCAE medications remained strongly and independently associated with falls in multivariable models adjusted for HIV serostatus, study site, sociodemographics, clinical characteristics, and substance use. CONCLUSIONS Polypharmacy and NCAE medication use were greater among WWH compared with HIV-, and both were independently and incrementally related to falls. Deprescribing and avoidance of medications with NCAEs may be an important consideration for reducing fall risk among WWH and sociodemographically similar women without HIV.
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Affiliation(s)
- Christina K Psomas
- Department of Infectious Diseases and Internal Medicine, European Hospital Marseille, Marseille, France
| | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ
| | - Qiuhu Shi
- Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY
| | - Todd T Brown
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - David E Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL
| | - Susan Holman
- Department of Medicine/STAR Program, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Phyllis C Tien
- Department of VA Medical Center, San Fransisco, CA
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Kathleen M Weber
- Department of Medicine, Cook County Health/CORE Center and Hektoen Institute of Medicine, Chicago, IL
| | | | - Hector H Bolivar
- Department of Medicine, University of Miami Health System, Miami, FL
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Kendra K Radtke
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Bani Tamraz
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
| | - Leah H Rubin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
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10
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Masters MC, Yang J, Lake JE, Abraham AG, Kingsley L, Brown TT, Palella FJ, Erlandson KM. Diabetes mellitus is associated with declines in physical function among men with and without HIV. AIDS 2022; 36:637-646. [PMID: 34999609 PMCID: PMC8957604 DOI: 10.1097/qad.0000000000003160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the longitudinal relationships between abnormal glucose metabolism and physical function in persons with HIV (PWH) and without HIV. DESIGN Prospective cohort study of men with or at risk for HIV in four United States cities between 2006 and 2018. METHODS Men with or at risk for HIV from the Multicenter AIDS Cohort Study (MACS) had semi-annual assessments of glycemic status, grip strength, and gait speed. We used linear mixed models with random intercept to assess associations between glycemic status and physical function. Glycemic status was categorized as normal, impaired fasting glucose (IFG), controlled diabetes mellitus [hemoglobin A1C (HbA1C) <7.5%], or uncontrolled diabetes mellitus (HbA1C ≥ 7.5%). RESULTS Of 2240 men, 52% were PWH. Diabetes mellitus was similar among PWH (7.7%) vs. persons without HIV (6.7%, P = 0.36) at baseline. PWH had slower gait speed (1.17 vs. 1.20 m/s, P < 0.01) but similar grip strength (40.1 vs. 39.8 kg, P = 0.76) compared with persons without HIV at baseline. In multivariate models, gait speed decline was greater with controlled diabetes mellitus [-0.018 m/s (-0.032 to -0.005), P = 0.01] and grip strength decline was greater with controlled [-0.560 kg (-1.096 to -0.024), P = 0.04] and uncontrolled diabetes mellitus [-0.937 kg (-1.684 to -0.190), P = 0.01), regardless of HIV serostatus compared with normoglycemic individuals. DISCUSSION Abnormal glucose metabolism was associated with declines in gait speed and grip strength regardless of HIV serostatus. These data suggest that improvement in glucose control should be investigated as an intervenable target to prevent progression of physical function limitations among PWH.
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Affiliation(s)
- Mary C Masters
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jingyan Yang
- Department of Epidemiology, Mailman School of Public Heath, Columbia University, New York, New York
| | - Jordan E Lake
- Department of Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Alison G Abraham
- Department of Ophthalmology, Johns Hopkins University School of Medicine
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Frank J Palella
- Department of Medicine, Northwestern University, Chicago, Illinois
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11
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Sung M, Gordon K, Edelman EJ, Akgün KM, Oursler KK, Justice AC. Polypharmacy and frailty among persons with HIV. AIDS Care 2021; 33:1492-1499. [PMID: 32880183 PMCID: PMC7925692 DOI: 10.1080/09540121.2020.1813872] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/18/2020] [Indexed: 12/13/2022]
Abstract
Polypharmacy is associated with frailty in the general population, but little is known about polypharmacy among persons living with HIV (PLWH) on antiretroviral (ARV) therapy. We determined the association between polypharmacy and an adapted frailty-related phenotype (aFRP) via a cross-sectional study in FY 2009 of 1762 PLWH on ARV with suppressed viral load and 2679 uninfected participants in the Veterans Aging Cohort Study. The primary predictor was number of chronic outpatient non-ARV medications using pharmacy fill/refill data. The outcome was self-report of four aFRP domains: shrinking, exhaustion, slowness, low physical activity. Frailty was defined as reporting 3-4 domains while pre-frailty was 1-2. Frailty was uncommon (2% PLWH, 3% uninfected); a larger proportion demonstrated any aFRP domain (31% PLWH, 41% uninfected). Among PLWH and uninfected, median chronic non-ARV medications was 6 and 16 respectively if having any aFRP domain, and 4 and 10 when without aFRP domains. In adjusted analyses, each additional chronic non-ARV medication conferred an 11% increased odds of having any aFRP domain in PLWH (OR [95% CI] = 1.11 [1.08, 1.14]), and a 4% increase in those uninfected (OR [95% CI] = 1.04 [1.03, 1.04]). The stronger association between polypharmacy and frailty in PLWH warrants further study and potential deprescribing of medications.
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Affiliation(s)
- Minhee Sung
- VA Health Services Research & Development, West Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kirsha Gordon
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - E. Jennifer Edelman
- Yale University School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| | - Kathleen M. Akgün
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Krisann K. Oursler
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Salem VA Medical Center, Salem, VA, USA
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
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12
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Erlandson KM, Piggott DA. Frailty and HIV: Moving from Characterization to Intervention. Curr HIV/AIDS Rep 2021; 18:157-175. [PMID: 33817767 PMCID: PMC8193917 DOI: 10.1007/s11904-021-00554-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW While the characteristics associated with frailty in people with HIV (PWH) have been well described, little is known regarding interventions to slow or reverse frailty. Here we review interventions to prevent or treat frailty in the general population and in people with HIV (PWH). RECENT FINDINGS Frailty interventions have primarily relied on nonpharmacologic interventions (e.g., exercise and nutrition). Although few have addressed frailty, many of these therapies have shown benefit on components of frailty including gait speed, strength, and low activity among PWH. When nonpharmacologic interventions are insufficient, pharmacologic interventions may be necessary. Many interventions have been tested in preclinical models, but few have been tested or shown benefit among older adults with or without HIV. Ultimately, pharmacologic and nonpharmacologic interventions have the potential to improve vulnerability that underlies frailty in PWH, though clinical data is currently sparse.
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Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, Division of Infectious Diseases, University of Colorado-Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA.
| | - Damani A Piggott
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA
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13
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Tolentino A, Amaral S, S Souza L, Zeballos D, Brites C. Frequency of Falls and Associated Risk Factors in People Living With HIV: A Systematic Review With Meta-Analysis and Meta-Regression. J Acquir Immune Defic Syndr 2021; 86:616-625. [PMID: 33351527 DOI: 10.1097/qai.0000000000002600] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Falls are considered as a predictive marker of poorer outcomes for people living with HIV (PLWHIV). However, the available evidences on the predictive value of falls are controversial. Our aim is to summarize the existing data about falls in PLWHIV. METHODS A literature search was conducted using electronic databases (MEDLINE, Embase, and LILACS) for original observational studies. The primary outcome was any and recurrent falls' frequency in PLWHIV, and secondary outcomes were factors associated with falls. We conducted a random-effects meta-analysis with meta-regression to obtain a summary frequency of falls and recurrent falls. RESULTS The pooled frequency for any fall was 26% [95% confidence interval (CI): 19% to 34%], compared with 14% for recurrent falls (95% CI: 9% to 22%). In studies comparing PLWHIV and people without HIV, we found no difference for any (pooled odds ratio 1.03, 95% CI: 0.90 to 1.17) or recurrent falls (pooled odds ratio 1.08, 95% CI: 0.92 to 1.27) between groups, but falls in middle-aged PLWHIV might be more associated with subjacent clinical conditions such as cognitive impairment, polypharmacy, use of medications with action in the central nervous system, and frailty, classic risk factors for falls in the elderly. CONCLUSIONS The overall frequency of falls in PLWHIV seems to be lower than that presented by some initial studies, and several factors associated with falls are shared with elderly adults. Although both PLWHIV and people without HIV presented similar frequency of falls, we found that these events might be qualitatively different; therefore, an appropriate method to evaluate falls in this population to prevent adverse outcomes is warranted.
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Affiliation(s)
- Arthur Tolentino
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Salvador, Brazil
| | - Sávio Amaral
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia, Salvador, Brazil; and
| | - Lucca S Souza
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Diana Zeballos
- Programa de Pós-graduação em Saúde Coletiva (PPgSC), Universidade Federal da Bahia, Salvador, Brazil
| | - Carlos Brites
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia, Salvador, Brazil; and
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14
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Charumbira MY, Berner K, Louw QA. Falls in people living with HIV: a scoping review. BMJ Open 2020; 10:e034872. [PMID: 33148721 PMCID: PMC7674634 DOI: 10.1136/bmjopen-2019-034872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Recent research has indicated seemingly increased propensity for falls and accelerated bone demineralisation in people living with HIV (PLWH). We aim to map out the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH. METHODS A scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Four databases were searched until October 2019 for peer-reviewed studies available in English reporting on the definition, prevalence, assessment, risk factors and interventions for falls in PLWH as well as information on bone demineralisation linked to falls in PLWH. Narrative reviews were excluded. Two reviewers independently performed the extraction using a predesigned Excel sheet. A descriptive analysis of extracted information was done. RESULTS Fourteen studies on falls in older PLWH were identified, with all but one study conducted in high-income countries. Prevalence of falls in PLWH ranged from 12% to 41%. Variable assessment tools/tests were used to assess potential risk factors, but it remains to be determined which are more predictive and appropriate for use among PLWH. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age-matched and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH. CONCLUSION More research is needed on falls in younger cohorts of PLWH and in sub-Saharan Africa where HIV is most prevalent and more robust clades exist. More studies need to report on data in seronegative controls to determine risk factors unique to PLWH. More intervention studies targeted at falls prevention and promotion of bone health are required. Quality clinical practice guidelines highlighting validated assessment tools and outcome measures need to be developed.
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Affiliation(s)
- Maria Yvonne Charumbira
- Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karina Berner
- Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Abegail Louw
- Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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15
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Polypharmacy, Hazardous Alcohol and Illicit Substance Use, and Serious Falls Among PLWH and Uninfected Comparators. J Acquir Immune Defic Syndr 2020; 82:305-313. [PMID: 31339866 DOI: 10.1097/qai.0000000000002130] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Medication classes, polypharmacy, and hazardous alcohol and illicit substance abuse may exhibit stronger associations with serious falls among persons living with HIV (PLWH) than with uninfected comparators. We investigated whether these associations differed by HIV status. SETTING Veterans Aging Cohort Study. METHODS We used a nested case-control design. Cases (N = 13,530) were those who fell. Falls were identified by external cause of injury codes and a machine-learning algorithm applied to radiology reports. Cases were matched to controls (N = 67,060) by age, race, sex, HIV status, duration of observation, and baseline date. Risk factors included medication classes, count of unique non-antiretroviral therapy (non-ART) medications, and hazardous alcohol and illicit substance use. We used unconditional logistic regression to evaluate associations. RESULTS Among PLWH, benzodiazepines [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.08 to 1.40] and muscle relaxants (OR 1.29; 95% CI: 1.08 to 1.46) were associated with serious falls but not among uninfected (P > 0.05). In both groups, key risk factors included non-ART medications (per 5 medications) (OR 1.20, 95% CI: 1.17 to 1.23), illicit substance use/abuse (OR 1.44; 95% CI: 1.34 to 1.55), hazardous alcohol use (OR 1.30; 95% CI: 1.23 to 1.37), and an opioid prescription (OR 1.35; 95% CI: 1.29 to 1.41). CONCLUSION Benzodiazepines and muscle relaxants were associated with serious falls among PLWH. Non-ART medication count, hazardous alcohol and illicit substance use, and opioid prescriptions were associated with serious falls in both groups. Prevention of serious falls should focus on reducing specific classes and absolute number of medications and both alcohol and illicit substance use.
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Abstract
PURPOSE OF REVIEW Update findings regarding polypharmacy among people with HIV (PWH) and consider what research is most needed. RECENT FINDINGS Among PWH, polypharmacy is common, occurs in middle age, and is predominantly driven by nonantiretroviral (ARV) medications. Many studies have demonstrated strong associations between polypharmacy and receipt of potentially inappropriate medications (PIMS), but few have considered actual adverse events. Falls, delirium, pneumonia, hospitalization, and mortality are associated with polypharmacy among PWH and risks remain after adjustment for severity of illness. SUMMARY Polypharmacy is a growing problem and mechanisms of injury likely include potentially inappropriate medications, total drug burden, known pairwise drug interactions, higher level drug interactions, drug--gene interactions, and drug--substance use interactions (alcohol, extra-medical prescription medication, and drug use). Before we can effectively design interventions, we need to use observational data to gain a better understanding of the modifiable mechanisms of injury. As sicker individuals take more medications, analyses must account for severity of illness. As self-report of substance use may be inaccurate, direct biomarkers, such as phosphatidylethanol (PEth) for alcohol are needed. Large samples including electronic health records, genetics, accurate measures of substance use, and state of the art statistical and artificial intelligence techniques are needed to advance our understanding and inform clinical management of polypharmacy in PWH.
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Affiliation(s)
| | - Christopher T. Rentsch
- VA Connecticut Healthcare System, West Haven, CT
- London School of Hygiene & Tropical Medicine, London, UK
| | - Amy C. Justice
- Yale Schools of Medicine and Public Health, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
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17
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Masters MC, Perez J, Tassiopoulos K, Andrade A, Ellis R, Yang J, Brown TT, Palella FJ, Erlandson KM. Gait Speed Decline Is Associated with Hemoglobin A1C, Neurocognitive Impairment, and Black Race in Persons with HIV. AIDS Res Hum Retroviruses 2019; 35:1065-1073. [PMID: 31468979 DOI: 10.1089/aid.2019.0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Gait speed declines at a faster rate in persons with HIV (PWH) than in the general population but the risk factors associated with this decline are not well understood. In the AIDS Clinical Trials Group (ACTG) A5322 (HAILO, HIV Infection, Aging, and Immune Function Long-term Observational Study), an observational cohort study of PWH ≥40 years of age, those who developed slow gait during the first 3 years of follow-up were compared with persons who maintained normal speed. Associations with demographic and clinical covariates were assessed using multivariable logistic regression. Of 929 participants, 81% were men, 31% Black, and 20% Hispanic. Median age was 51 years [interquartile range (IQR) = 46-56]. At study entry, 92% had plasma HIV RNA <50 copies/mL with median CD4 count 631 cells/mm3 (IQR = 458-840). At study entry, 7% of participants had slow gait, 16% had neurocognitive impairment (NCI), and 12% had diabetes. Over 3 years, 87% maintained normal gait speed, 3% maintained a slow gait, 6% developed a slow gait, and 4% improved from slow to normal gait speed. In multivariable models, hemoglobin A1C (HbA1C) percentage, per one unit increase [odds ratio (OR) = 1.36; 95% confidence interval (CI) = 1.03-1.81; p = .033], NCI (OR = 3.47; 95% CI = 1.57-7.69 p = .002), and black versus white race (OR = 2.45; 95% CI = 1.08-5.59; p = .032) at entry were significantly associated with development of slow gait compared with those maintaining normal gait speed. The association between baseline HbA1C and development of slow gait speed highlights an intervenable target to prevent progression of physical function limitations.
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Affiliation(s)
- Mary Clare Masters
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois
| | - Jeremiah Perez
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Ronald Ellis
- Department of Neurosciences, University of California, San Diego, California
| | - Jingyan Yang
- Mailman School of Public Health, Columbia University, New York, New York
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois
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Berner K, Strijdom H, Essop MF, Webster I, Morris L, Louw Q. Fall History and Associated Factors Among Adults Living With HIV-1 in the Cape Winelands, South Africa: An Exploratory Investigation. Open Forum Infect Dis 2019; 6:ofz401. [PMID: 31660363 PMCID: PMC6785680 DOI: 10.1093/ofid/ofz401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background People with HIV-1 (PWH) exhibit a high fall incidence and increased fracture risk. As little is known about fall frequency and associated factors in PWH residing in lower-middle-income countries (LMIC), we investigated fall frequency, bone quality, and factors associated with fall history in a South African cohort. Methods Fifty PWH without obvious predisposing factors for mobility impairments attending 2 public primary care clinics in the Western Cape region participated. Demographic, clinical, and physical performance data were collected. Falls were assessed retrospectively over 12 months. Mobility and balance were evaluated using a physical performance battery. Bone mineral density was screened using quantitative ultrasound (QUS). Associations between variables and falls grouping were analyzed using chi-square tests, t tests, and Mann-Whitney U tests, and effect sizes (ES) were calculated. Results Thirty-four percent of PWH (median age, 36.6 years) reported falling during the past year, and 41.2% of fallers reported multiple falls. Fallers had more mobility problems (P = .013), higher fear of falling (P = .007), higher fracture history (P = .003), worse balance performance (P < .001), higher proportions of detectable viral loads (P = .021), and poorer bone quality (P = .040). Differences were of medium to large ES. Conclusions This exploratory study is the first to show that relatively young South African PWH without obvious predisposing factors for gait and balance impairments experience falls. The observed fall-associated factors warrant further research using larger samples and longitudinal designs to ascertain fall predictors within this population.
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Affiliation(s)
- Karina Berner
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hans Strijdom
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Faadiel Essop
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ingrid Webster
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Linzette Morris
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Sirois C, Simard M, Gosselin E, Gagnon ME, Roux B, Laroche ML. Mixed Bag “Polypharmacy”: Methodological Pitfalls and Challenges of This Exposure Definition. CURR EPIDEMIOL REP 2019. [DOI: 10.1007/s40471-019-00214-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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20
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Deren S, Cortes T, Dickson VV, Guilamo-Ramos V, Han BH, Karpiak S, Naegle M, Ompad DC, Wu B. Substance Use Among Older People Living With HIV: Challenges for Health Care Providers. Front Public Health 2019; 7:94. [PMID: 31069208 PMCID: PMC6491638 DOI: 10.3389/fpubh.2019.00094] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/04/2019] [Indexed: 12/17/2022] Open
Abstract
Older people living with HIV (OPLWH) have higher rates of substance use (tobacco, alcohol, and other drugs) than their HIV-negative peers. Addressing health care needs of OPLWH who use substances is more challenging than for those who do not: they are highly impacted by comorbid conditions, substance use can interact with other medications (including antiretroviral therapy-ART) and reduce their effectiveness, and substance use has been associated with reduced adherence to ART and increased risky behaviors (including sexual risks). People who use substances also suffer disparities along the HIV continuum of care, resulting in lower viral suppression rates and poorer health outcomes. They are especially impacted by stigma and stress, which have implications for HIV treatment and care. Recommendations for health care providers working with OPLWH who use substances include: (1) the need to screen and refer for multiple associated conditions, and (2) training/continuing education to enhance care management and maximize health outcomes.
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Affiliation(s)
- Sherry Deren
- Center for Drug Use and HIV Research, College of Global Public Health, New York University, New York, NY, United States
| | - Tara Cortes
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | | | | | - Benjamin H Han
- Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Stephen Karpiak
- Gay Men's Health Crisis, AIDS Community Research Initiative of America Center on HIV and Aging, New York, NY, United States
| | - Madeline Naegle
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Danielle C Ompad
- Center for Drug Use and HIV Research, College of Global Public Health, New York University, New York, NY, United States
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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Womack JA, Novick G, Fried T. The beginning of the end: A qualitative study of falls among HIV+ individuals. PLoS One 2018; 13:e0207006. [PMID: 30408088 PMCID: PMC6224109 DOI: 10.1371/journal.pone.0207006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/23/2018] [Indexed: 12/17/2022] Open
Abstract
Falls are an important concern for individuals living with HIV (HIV+). The purpose of this study was to understand perceptions of HIV+ individuals who had fallen regarding what caused their falls, prevention strategies that they used, and the impact of falls on their lives. Qualitative Description was the approach best suited to our study. We conducted in-depth interviews with 21 HIV+ individuals aged 47 to 71 years who had fallen within the past two years and who received care in a primary care/HIV clinic. Participants identified causes of falls as intrinsic (HIV, opportunistic infections, antiretroviral therapy, substance use, polypharmacy) or extrinsic (icy sidewalks, wet floors). Among those who felt that their falls could be prevented, prevention strategies included physical therapy and avoiding extrinsic fall risk factors. Some participants, however, felt that their falls could not be prevented. While some participants responded adaptively to falls, for many, the experience of falling was connected with deep feelings of loss and suffering. For these individuals, falls were understood to be "the beginning of the end" and a source of social isolation, changing family roles, diminished sense of self, and stigma.
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Affiliation(s)
- Julie A. Womack
- VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Nursing, West Haven, CT, United States of America
| | - Gina Novick
- Yale School of Nursing, West Haven, CT, United States of America
| | - Terri Fried
- VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Internal Medicine, Division of Geriatrics, Yale School of Medicine, New Haven, CT, United States of America
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