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  9th International
Workshop on HIV and Aging
13 and 14 September 2018
New York City, NY
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People taking more medications and women
have higher fall risk in older HIV group

  9th International Workshop on HIV and Aging, September 13-14, 2018, New York from Jules: another key topic at this meeting was "deprescribing". A presentation by Leah Rubin and much discussion focused on that older aging HIV+ may be taking too many medications, and tha consideration should be given to "deprescribing", meaning that perhaps less medications should be given because giving so many medications be be more harmful overall than beneficial. This is an important issue and that needs due consideration by both patients and their clinicians. As mentioned Leah Rubin's presentation and publication found many HIV+ are receiving medications that might increase cognitive impairment and this may increase adverse events & as this study suggests increased fall risk. I will redistribute Rubin's publication and report her slide presentation on this important question.
Mark Mascolini
Women in a US HIV clinic population had more than a 50% higher risk of falling than men, according to results of a 2208-person case-control study [1]. Every additional medication taken boosted odds of falling almost 10% in this retrospective analysis of men and women with HIV.
Falls become more prevalent as people with and without HIV age. And because people with HIV often have low bone mineral density, falls pose a concerning risk of fracture. In a prior US study of 359 people with HIV, 30% reported 1 or more falls; odds of falling were 1.7-fold higher with each additional comorbidity and 1.4-fold higher with each additional medication [2]. A comparison of 536 HIV-positive and negative men and women in two US cohorts recorded self-reported fall rates of 24% in people with HIV and 18% in HIV-negative people at risk for HIV infection [3].
University of California, San Diego (UCSD) researchers reviewed records of HIV-positive people 50 or older seen in their clinic from September 2012 to August 2017. They retrospectively determined which people had a documented fall (cases) and which did not (controls). The investigators used logistic regression analysis to identify fall predictors.
Among 2208 people studied, 643 fell and 1565 did not. Cases with falls did not differ from controls without falls in race, ethnicity, CD4 count, or viral load at the time of the fall. Univariate analysis identified 4 fall predictors: (1) older age: (average 59.0 versus 57.5 years, P < 0.0001), (2) female gender (17.1% versus 10.3%, P < 0.001), (3) taking more total medications (average 11.2 versus 7.5, P <0.001), and (4) taking more antiretrovirals (average 3.8 versus 3.3, P < 0.0001).
Multivariate analysis confirmed older age, female gender, and more medications as independent predictors of falls. For female gender and each additional medication, the adjusted odds ratios (aOR) and 95% confidence intervals (CI) were:
-- Female gender: aOR 1.56, 95% CI 1.18 to 2.05 -- Each additional medication taken: aOR 1.09, 95% CI 1.07 to 1.11
The UCSD findings confirmed the impact of polypharmacy on falls in people with HIV seen in a prior smaller study [2]. The researchers endorsed study of limiting prescriptions in HIV-positive people taking high numbers of drugs "to prevent harmful outcomes" such as falls.
1. Thai L, Young M. The impact of number of medications on falls in aging persons living with HIV. 9th International Workshop on HIV and Aging, September 13-14, 2018, New York. Abstract 4.
2. Erlandson KM, Allshouse AA, Jankowski CM, et al. Risk factors for falls in HIV-infected persons. J Acquir Immune Defic Syndr. 2012;61:484-489. www.natap.org/2016/HIV/Risk_Factors_for_Falls_in_HIV_Infected_Persons.11.pdf
3. Erlandson KM, Plankey MW, Springer G, et al. Fall frequency and associated factors among men and women with or at risk for HIV infection. HIV Med. 2016;17:740-748.