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Cognitive Complaints and Development of Falls among HIV-Infected and Uninfected Women
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.....from Jules: its important to bear in mind that the control group here is not a healthy control group but similar characteristics in both group except for HIV status, so both groups have a history drug use & similarly high rates of comorbidities, so fall rates were similar in both WIHS groups, HIV+ and HIV-neg, for HIV+ women: 15.% had a single fall, 25.4% 2 falls, and 15.4% any fall with an injury; and HIV-neg group it was 18.4% with a single fall, 23.9% with 2 falls, and 18.9% with any fall with an injury; 2.5% in each group had a fall with a fracture. The average age of women were 47-49 [range 40-54], relatively young. Cognitive complaints (self-reported major problems with memory or concentration, confusion, or inability to perform routine mental tasks) by women were associated with increased odds of having a fall "however this association was reduced by 34% after fully adjusting for covariates associated with falls; among HIV+ women, subjective cognitive complaints were no longer significantly associated with falls after adjusting for medical comorbidities. Among HIV+ women, the association between cognitive complaints and falls appears to be mediated by comorbid medical illness. Additional studies are needed to understand mechanisms by which comorbid diseases affect both cognition and fall risk among aging HIV+ women." So the study finds having comorbid conditions appears associated with increased risk of falls. Personally I believe cognitive problems increase risk for falls, and having comorbid conditions also increase risk, probably having renal disease, CVD, diabetes, HCV, depression also can cause increase cognitive impairment, having multiple comorbidities likely increase cognitive impairment.
Reported by Jules Levin
CROI 201 Feb 14-16 Seattle, WA
Anjali Sharma1, Donald R. Hoover2, Qiuhu Shi3, Susan Holman4, Michael W. Plankey5, Phyllis Tien6,7, Kathleen Weber8, Michelle Floris-Moore9, Hector H. Bolivar10, David E. Vance11, Elizabeth T. Golub12, Marcia Holstad13, and Michael T. Yin14
We previously reported greater fracture rates in aging HIV+ vs. HIV- women in the Women's Interagency HIV Study (WIHS).
from Jules: remember the HIV-neg group in WIHS is not a healthy control group but women with similar characteristics except they are HIV-neg, see Table 1 below about 40% have past cocaine, crack or heroin use & 8-12% current use. 19-24% current marijuana use. Both groups report similar percentages of them have subjective cognitive impairments 10-12% with more peripheral neuropathy in HIV+ which can increase risk for a fall.
The study found predictors of any fall in HIV+ were (see Table 2 below): age (per 10 years), marijuana use, taking CNS active medications with women taking 2 at greater risk than taking 1 and much more risk for a fall when taking 3 CNS medications, and comorbidities including HCV, hypertension, depression, peripheral neuropathy. After adjusting
"Subjective cognitive complaints were associated with increased odds of having any fall, however this association was reduced by 34% after fully adjusting for covariates associated with falls; among HIV+ women, subjective cognitive complaints were no longer significantly associated with falls after adjusting for medical comorbidities."
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