 |
|
|
| |
Cognition, Depression, Neuropathy Predict Falls in WIHS Women With or Without HIV
|
| |
| |
WIHS - Bone Microarchitecture, Not Just BMD, Worse in Women With Than Without HIV.......The researchers noted that this is the first study that demonstrates microstructural differences in bone (not just density differences) between women with and without HIV. Reported last week by same WIHS researcher - A Sharma
--------------
7th International Workshop on HIV and Aging, September 26-27, Washington, DC
Mark Mascolini
An 18-month study of almost 1900 HIV-positive and negative women in the Women's Interagency HIV Study (WIHS) identified cognitive complaints, depression, neuropathy, and other comorbidities as risk factors for self-reported falls [1]. Although older and more often affected by neuropathy, women with HIV did not fall more than women without HIV. [from Jules: but the comparator group in WIHS is not representative of healthy women in US].... http://www.natap.org/2016/CROI/croi_147.htm...... [CROI/2016: Prevalence of Falls among Older Women in the Women's Interagency HIV Study - depression, current crack, cocaine, heroin, cognitive complaints, neuropathy use associated with falls]
HIV-positive women have lower bone mineral density than women without HIV, and a prior WIHS analysis found a higher fracture incidence in middle-aged women with than without HIV [2]. In this previously reported study, cocaine use and a history of injection drug use independently predicted incident fracture. ....http://www.natap.org/2015/CROI/croi_54.htm
The new study involved HIV-positive women and demographically similar HIV-negative women who made three WIHS study visits over the course of 18 months. The researchers used a multivariate generalized estimating equation model to assess risk of at least one reported fall during the 18 months of follow-up.
The 1289 women with HIV were significantly older than the 587 women without HIV (median 49 versus 47 years, P = 0.0002). About three quarters of both groups were black, about two thirds had at least a high school education, and about half had an annual income of $12,000 or more. A lower proportion of women with than without HIV were obese (48% versus 58%, P < 0.0001).
While 11% of the HIV-positive and negative groups reported subjective cognitive complaints, a higher proportion of women with HIV had neuropathy (20% versus 16%, P = 0.02), a higher proportion had an estimated glomerular filtration rate (eGFR) below 60 mL/min (9% versus 6%, P = 0.01), and a higher proportion had HCV infection (12% versus 8%, P = 0.005). Similar proportions of women with and without HIV had depressive symptoms indicated by a CES-D score* at or above 16 (29% and 30%).
Among women with HIV, median current CD4 count measured 586 and nadir CD4 count 279. While 88% of HIV-positive women were taking antiretroviral therapy, 63% had a viral load below 200 copies.
Rates of self-reported falls in the 6 months before each study visit hardly differed between women with and without HIV: 18% versus 18% at the first visit, 17% versus 18% at the second visit, and 18% versus 18% at the third visit.
In the combined group, predictors of any fall included older age (odds ratio [OR] 1.34 per 10 years older, P < 0.001), neuropathy (OR 2.37, P < 0.001), CES-D score at or above 16 (OR 2.03, P < 0.001), diabetes (OR 1.32, P = 0.006), eGFR below 60 mL/min (aOR 1.73, P < 0.001), hypertension (OR 1.73, P < 0.001), and HCV infection (OR 1.69, P < 0.001). HIV infection did not independently predict falls.
Factors associated with lower odds of any fall were income at or above $12,000 (OR 0.69, P < 0.001), WIHS enrollment in 2001-2002 versus 1994-1995 (OR 0.58, P < 0.001), and heterosexual HIV transmission versus drug injection (OR 0.68, P = 0.001).
In additional analyses, subjective cognitive complaints more than doubled chances of any fall in the combined group of women with and without HIV (OR 2.60, P < 0.0001) and in the HIV group alone (OR 2.30, P < 0.0001). When that model was further adjusted for demographics, subjective cognitive complaints remained an independent predictor of any fall for the combined group (OR 2.30, P < 0.0001) and for the HIV group alone (OR 2.03, P < 0.0001). After further adjustment for comorbidities, subjective cognitive complaints remained an independent predictor of any fall in the combined group (OR 1.46, P = 0.006) but not in the HIV group alone (OR 1.23, 95% confidence interval 0.89 to 1.71, P = 0.20). Even after further adjustment for substance abuse and use of central nervous system agents, subjective cognitive complaints remained an independent predictor of any fall in the combined group (OR 1.42, P = 0.01).
The WIHS investigators called for further study to determine whether falls cause fractures more in women with than without HIV as they age.
References
1. Sharma A, Hoover DR, Shi Q, et al. Longitudinal study of falls among HIV-infected and uninfected women: results from the Women's Interagency HIV Study. 7th International Workshop on HIV and Aging, September 26-27, Washington, DC. Abstract 4.
2. Sharma A, Shi Q, Hoover DR, et al. Increased fracture incidence in middle-aged HIV-infected and HIV-uninfected women: updated results from the Women's Interagency HIV Study. J Acquir Immune Defic Syndr. 2015;70:54-61. http://www.natap.org/2015/HIV/Increased_Fracture_Incidence_in_Middle_Aged.7.pdf
*CES-D, Center for Epidemiologic Studies Depression Scale.
|
| |
|
|
|
|
|
