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HIV+ Women - Frailty / Falls / Fracture / Mortality
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Soon 80% with diagnosed HIV in the USA will be over 50 years old. In the USA fractures cost $20 billion year and it will cost $25 billion in 7 years. The cost of aging in HIV will skyrocket. Healthcare costs will skyrocket. Many HIV+ will be suffering ravages of aging. WE WILL NEED INTENSIVE TIME-CONSUMING SERVICES for AGING HIV+ including more demanding care. The cost for fractures alone will be a very significant sum. CVD is 50% higher in HIV+. Kidney disease is 2-4 times greater in HIV+. Cognitive impairment is 50% among HIV+ and worsens with time. Frailty & disability occurs at higher rates and at earlier age in HIV+. Get my point !
HIV+ Women & Frailty / Falls/ Fracture, Mortality......from Jules: HIV+ are at great risk for osteopenia, osteoporosis and falls & fractures, and thusly greater mortality. Women in WIHS have high rates of falls & fractures, ever use of cocaine & IDU increase risk, so does depression, frailty & comorbidities. Studies below report 25% to 40% fall rates in women with HIV, a fall is a big predictor of a fracture, a fracture to an older person increases mortality, its very hard to recover from a fracture after 65 years old.
.......odds ratio (OR) of osteoporosis among HIV-infected individuals compared with HIV-uninfected controls was 3.7.... Low bone mineral density and risk of incident fracture in HIV-infected adults.....'reconsider when to screen for low BMD with DEXA' - (04/01/16)....low baseline BMD was significantly associated with elevated risk of incident fracture.....36% (n=358) had osteopenia and 4% (n=37) osteoporosis.... 85 incident fractures occurred....osteoporosis (adjusted hazard ratio [aHR] 4.02, 95% CI 2.02, 8.01) and current/prior tobacco use (aHR 1.59, 95% CI 1.02, 2.50) were associated with incident fracture
"HIV+ persons have 1.5-3.0-fold greater risk of fractures"....http://natap.org/2016/CROI/croi_24.htm
1. Fracture incidence is increased in aging HIV-infected women (WIHS) by 30% vs HIV-- - (03/02/15)
Cocaine us ever increased fracture risk by 58%, injection drug use ever increased fracture risk by 38%; every 10 year increase in age."Fracture rates were higher among HIV+ than HIV- women. Cocaine and injection drug use were also significant predictors of incident fracture" " of note age matters, every 10-year increase in age increased risk for fracture in HIV+ women by 25%, see Table 5"
see Table 2, wrist fractures occurred more often in HIV+ women" "Adjusted for age, race, prior fracture, and history of cocaine and injection drug use, HIV+ women had significantly higher incidence rate of any fracture compared with HIV- women - 30% higher risk -(aHR1.30; 95% CI 1.02-1.66). Among HIV+ women, older age, white race, prior fracture, smoking, and prior AIDS defining illness(aHR=1.56; 95% CI: 1.22-1.98) significantly predicted new fracture, while CD4+ count and antiretroviral exposure did not."
2. Prevalence of Falls among Older Women in the Women's Interagency HIV Study - (03/10/16)
.....depression, current crack, cocaine, heroin, cognitive complaints, neuropathy use associated with falls, as well as age: women over 50 at greater risk & women of 60 at even more risk
3. "40% reported falls in the previous year/HIV+ in VA Aging
Cohort"....http://www.natap.org/2014/IDSA/IDSA_42.htm
WHO IS MANAGING AGING PATIENTS & THEIR RISK FOR FALLS ? No ONE - Jules Levin, NATAP - (02/09/17)median age 57....mean CD4 count 507...40% reported falls in the previous year
Use of Cocaine, Meth, Opioids Remains High in US MSM: 2008-2014 - (03/30/17)
Poor balance confidence [fear of falling] --not physical function--predicts falls in older men with HIV - (02/23/15)
4. Cognitive Complaints and Development of Falls among HIV-Infected and Uninfected Women - (03/06/17)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. 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% had a fall with a fracture
5. Frailty Predicts Recurrent but Not Single Falls 10 Years Later in HIV+ and HIV- Women - (11/04/17) 25% of HIV+ middle aged women in WIHS (36-48) experienced 2+ falls. In WIHS very important to understand HIV-neg women have same background as HIV+ women.
Frailty Status and Risk of Falls in HIV-Infected Older Adults in the ACTG A5322 Study - (03/22/17) Frailty in HIV+ increases fall risk 2 to 17 times
Fractures Occur at a Younger Age in HIV+ Men in the Multicenter AIDS Cohort Study - (03/14/16)
HIV Infection and the Occurrence of Medically Significant Falls: Accelerated or Accentuated Aging? - - (04/06/17)
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