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Kim TW, Bertholet N, Magane KM, Lloyd-Travaglini C, Winter MR, Samet JH, Erlandson KM, Stein MD, Bryant KJ, Saitz R, Heeren TC. Alcohol Consumption and Illicit Drug Use: Associations With Fall, Fracture, and Acute Health Care Utilization Among People With HIV Infection. J Acquir Immune Defic Syndr 2024; 95:391-398. [PMID: 38133581 PMCID: PMC10922845 DOI: 10.1097/qai.0000000000003372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Given alcohol and/or other drug (AOD) use occurs among people with HIV (PWH), we examined its association with falls and fall-related outcomes and whether frailty moderates the association. SETTING Northeastern US city. METHODS We analyzed an observational cohort of PWH with current or past AOD use. Alcohol measures were any past 14-day heavy use, average alcohol/day, and days with heavy use. Drug use measures were past 30-day illicit use of cocaine, opioids, and sedatives. Repeated cross-sectional associations were estimated with separate multivariable generalized estimating equation regression models for each fall-related outcome. RESULTS Among PWH (n = 251; mean age 52 [SD = 10]), 35% reported heavy alcohol use, 24% cocaine, 16% illicit opioids, 13% illicit sedatives, and 35% any fall; 27% were frail. Heavy alcohol use was associated with a fall (AOR = 1.49, 95% CI: 1.08 to 2.07), multiple falls (AOR = 1.55 95% CI: 1.10 to 2.19), and fall/fracture-related emergency department visit or hospitalization (AOR = 1.81, 95% CI: 1.10 to 2.97). Higher average alcohol/day and more heavy drinking days were associated with multiple falls. Illicit sedative use was associated with a fall, multiple falls, and emergency department visit/hospitalization and opioid use with fracture. Frailty moderated the association of heavy alcohol use and a fall (AOR = 2.26, 95% CI: 1.28 to 4.01 in those frail) but not in those not frail. CONCLUSION The effect of AOD use on falls and fall-related outcomes was most pronounced with alcohol, particularly among frail PWH. Heavy alcohol, illicit sedative, and illicit opioid use are high-priority targets for preventing falls and fall-related consequences for PWH.
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Affiliation(s)
- Theresa W Kim
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA
- Department of Medicine, Boston Medical Center, Boston, MA
| | - Nicolas Bertholet
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kara M Magane
- Boston University School of Public Health, Boston, MA
| | | | | | - Jeffrey H Samet
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA
- Department of Medicine, Boston Medical Center, Boston, MA
- Boston University School of Public Health, Boston, MA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; and
| | | | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD
| | - Richard Saitz
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA
- Department of Medicine, Boston Medical Center, Boston, MA
- Boston University School of Public Health, Boston, MA
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Abstract
OBJECTIVES AND DESIGN Frailty is a phenotype associated with adverse health outcomes in older persons. It has been evaluated mainly in middle-aged persons with HIV (PWH). The French multicenter prospective ANRS EP66 SEPTAVIH study aimed to assess frailty prevalence and risk factors in PWH aged 70 years or older on antiretroviral treatment (ART) for at least 12 months. METHODS At baseline, Fried frailty phenotype criteria, sociodemographic data, medical/HIV history, functional status, comorbidities, including impaired cognitive function, depression, history of falls, and co-medications were collected. We measured the prevalence of frailty and compared the characteristics of frail versus prefrail and robust participants using univariate (Kruskal-Wallis tests for continuous variables and Chi 2 tests for categorical variables) and multivariate analyses. RESULTS Five hundred and ten PWH, mostly male (81.4%), were included with a median age of 73 years. The median HIV and ART durations were 22.7 years and 15.7 years, respectively. The prevalence of frailty was 13.5%, and of prefrailty 63.3%. In the multivariate analysis, increasing age [odds ratio (OR) 1.79 for each 5-year increment; 95% confidence interval (CI) 1.32-2.41], deprived socioeconomic status (OR 3.17; 95% CI 1.76-5.70), and multimorbidities (three or more) (OR 2.03; 95% CI 1.06-3.90) were associated with frailty. CONCLUSION A low prevalence of frailty was reported (13.5%) in PWH aged 70 years or older, whereas two-thirds of them were prefrail. Age, low socioeconomic status, and multimorbidities, but no HIV-related factors, were associated with frailty, suggesting the need to target these factors to help promoting successful aging in this population.
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Zhou Q, He J, Yang X, Yin H, Zhang Z, He N. The association between physical frailty and injurious falls and all-cause mortality as negative health outcomes in people living with HIV: A systematic review and meta-analysis. Int J Infect Dis 2023; 126:193-199. [PMID: 36455810 DOI: 10.1016/j.ijid.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Physical frailty is one of the major concerns among older people living with HIV (PLWH). This meta-analysis aimed to explore the association between physical frailty and negative health outcomes among PLWH. METHODS We systematically searched six electronic databases including PubMed, Embase, Web of Science, the Cochrane Library, and Chinese databases up to April 10, 2022, for studies examining the association between physical frailty and risk of negative health outcomes among PLWH. Risk ratios (RRs), odds ratios, and hazard ratios with 95% CIs were extracted, and meta-analyses were conducted by using a fixed or random-effects model. RESULTS In total, 10 studies incorporating 7755 HIV-seropositive patients (mean age 49.4 years) were included in the meta-analysis. Overall, five studies with 3434 participants reported the effect of physical frailty on falls. Results showed that physical frailty in HIV-seropositive individuals demonstrated a higher risk of future falls (pooled RR 3.74, 95% CI 1.42-9.86) compared with robust HIV-seropositive patients. In addition, a meta-analysis of five studies (4321 participants) reporting the frailty-mortality association showed that physical frailty was significantly associated with a higher risk of all-cause mortality (RR 1.70, 95% CI 1.32-2.19) among PLWH. CONCLUSION Physical frailty is a significant risk factor for negative health outcomes in PLWH, including falls and all-cause mortality, underscoring the need for routine screening and early intervention of physical frailty among PLWH.
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Affiliation(s)
- Qionggui Zhou
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Yi-Wu Research Institute, Fudan University, Shanghai, China
| | - Jiayu He
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xuan Yang
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Hao Yin
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Zhiyi Zhang
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Na He
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Yi-Wu Research Institute, Fudan University, Shanghai, China.
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Sullivan EV, Zahr NM, Sassoon SA, Pfefferbaum A. Aging Accelerates Postural Instability in HIV Infection: Contributing Sensory Biomarkers. J Neuroimmune Pharmacol 2022; 17:538-552. [PMID: 34997916 PMCID: PMC9262994 DOI: 10.1007/s11481-021-10039-y] [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] [Received: 07/03/2021] [Accepted: 11/24/2021] [Indexed: 01/13/2023]
Abstract
People living with HIV infection (PWH) who are adequately treated pharmacologically are now likely to have a near normal life span. Along with this benefit of the aging HIV population are potential physical problems attendant to aging, including postural stability. Whether aging with HIV accelerates age-related liability for postural instability and what sensory factors contribute to imbalance were examined in 227 PWH and 137 people living without HIV (PWoH), age 25 to 75 years. A mixed cross-sectional/longitudinal design revealed steeper aging trajectories of the PWH than PWoH in sway path length, measured as center-of-pressure micro-displacements with a force platform while a person attempted to stand still. Sway paths were disproportionately longer for PWH than PWoH when tested with eyes closed than open. Multiple regression identified objective measures of sensory perception as unique predictors of sway path length, whereas age, sway path length, and self-reports of falls were predictors of standing on one leg, a common measure of ataxia. Knowledge about sensory signs and symptoms of imbalance in postural stability with and without visual information may serve as modifiable risk factors for averting instability and liability for falls in the aging HIV population.
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Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, MC5723, 401 Quarry Road, Stanford, CA, USA.
- Center for Health Sciences, SRI International, Menlo Park, CA, USA.
| | - Natalie M Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, MC5723, 401 Quarry Road, Stanford, CA, USA
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | | | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, MC5723, 401 Quarry Road, Stanford, CA, USA
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
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Abstract
PURPOSE OF REVIEW The HIV population is ageing with rising rates of frailty though strategies of how best to manage it remain ill-defined. It also remains unclear what the prevalence of frailty is within this cohort, how best to diagnose it and what factors are associated. RECENT FINDINGS The prevalence of frailty remains unclear because of heterogenous results. Routine screening in those 50+ is recommended and whilst the Fried Frailty Phenotype is currently preferred the Clinical Frailty Scale could be considered. No biomarkers are currently recommended. Looking at associated factors, HIV neurocognitive impairment and long-term alcohol usage has been shown to be associated with developing frailty whilst those who are frail have been shown to be less active and more likely to fall. NAFLD with fibrosis has been shown to be an indicator of metabolic age and the Pooled Cohort Equations has been shown to be more effective in diagnosing cardiovascular risk in frail people living with HIV. SUMMARY Whilst the prevalence of frailty differs between countries, with the addition of prefrailty, this represents a large proportion of people living with HIV. Services must ensure strategies are in place to support those living with HIV and frailty. Further longitudinal studies are required.
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Affiliation(s)
- Howell T Jones
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Tom Levett
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Tristan J Barber
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
- Institute for Global Health, UCL, London, Institute of Child Health, London, UK
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