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Detectable viral load quadruples odds of recurrent falls in older men with HIV
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from Jules: a theme at this meeting was that certain non-HIV drugs people with HIV are taking might increase adverse events more than anticipated including causing cognitive impairment. NATAP is reporting these presentations including by Leah Rubin and an associated pub;ication which I reported that finds increased cognitive impairment associated with taking certain non-HIV medications. THIS study highlights the risk of increasing cognitive impairment with these types of drugs & this study reports efavirenz use as a culprit in causing falls. This study found detectable viral load as associated with increased risk of fall, perhaps detectable viral load for these individuals might be assocu=iated with greater cognitive impairment or walking imbalance, as well as peripheral neuropathy more obviously as an associated cause for increased fall risk as reported in this study
9th International Workshop on HIV and Aging, September 13-14, 2018, New York
Mark Mascolini
Having a detectable viral load quadrupled odds of recurrent falls in a large analysis of older men with or without HIV in the Multicenter AIDS Cohort Study (MACS) [1]. Taking diabetes or depression medications, taking efavirenz, and having peripheral neuropathy also boosted odds of falling in this 2-year study, but HIV did not emerge as a fall risk factor.
Falls and fall risk factors are frequent in older people with and without HIV. A prior study of 359 HIV-positive men and women 45 to 65 years old identified female gender, diabetes, antidepressants, sedatives, opiates, didanosine, exhaustion, weight loss, and balance difficulties as the strongest independent predictors of falling in the past 12 months [2]. A prospective study of 967 HIV-positive men and women at least 40 years old determined that frailty independently raised odds of recurrent falls 17-fold, while prefrailty almost quadrupled odds of recurrent falls [3].
The new analysis involved men 50 to 75 years old enrolled in the Bone Strength Substudy of the MACS, which tracks HIV-positive men who have sex with men (MSM) and HIV-negative MSM at risk for HIV. Researchers recorded new falls in real time over a 2-year period. They used multinomial logistic regression to identify predictors of falling in an analysis that adjusted for HIV status, age, race, study site, enrollment period, body mass index, illicit drug use, peripheral neuropathy, and diagnosis of and medications for depression, diabetes, and hypertension.
Compared with the 379 HIV-negative men, 279 HIV-positive men were younger (61.1 versus 62.4 years, P < 0.001), included a lower proportion of whites (71% versus 82%, P = 0.001), had a lower body mass index (25.2 versus 26.1 kg/m2, P = 0.004), had higher diabetes prevalence (18% versus 12%, P = 0.034), and used depression medications more (30% versus 18%, P < 0.001). About 45% of men with or without HIV used illicit drugs. Most men with HIV, 91%, had a viral load below 50 copies.
Dividing study participants into subgroups of 23 HIV-positive men with a detectable viral load (viremic), 256 HIV-positive men with an undetectable viral load, and 379 men without HIV, the researchers determined respective single-fall rates of 13%, 22%, and 22%. Recurrent fall rates in those 3 groups were 35%, 18%, and 17%. About 10% of recorded falls led to injury and almost 5% caused fracture.
Men with HIV reported having a pet as a reason for a fall more than men without HIV (9.4% versus 3.8%, P = 0.008). Among all men, those with poor balance confidence and slower time to rise from a chair proved more likely to have recurrent falls.
Multivariate analysis did not link HIV infection to higher odds of falling, but 3 variables emerged as independent predictors of falling in the combined HIV-positive and negative group: taking diabetes drugs, peripheral neuropathy, and illicit drug use. Five variables independently predicted recurrent falls in the combined HIV-positive and negative group: taking diabetes drugs, taking antidepressants, peripheral neuropathy, illicit drug use, and every additional 5 years of age.
Among men with HIV, a detectable viral load (versus an undetectable load) independently predicted 4-fold higher odds of recurrent falls. Four other variables independently predicted recurrent falls: efavirenz use (about 4-fold higher odds), taking diabetes drugs (about 4-fold higher odds), peripheral neuropathy (about 2-fold higher odds), and illicit drug use (about 2-fold higher odds).
The researchers suggested their findings support fall prevention through physical activity, antiretroviral adherence, transition to nonefavirenz regimens, and counseling about pets, curbs, and other physical hazards.
References
1. Erlandson K, Zhang L, Ng D, et al. HIV-1 viremia is an independent risk factor for falls among older men with or at risk for HIV infection. 9th International Workshop on HIV and Aging, September 13-14, 2018, New York. Abstract 22.
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. Tassiopoulos K, Abdo M, Wu K, et al. Frailty is strongly associated with increased risk of recurrent falls among older HIV-infected adults. AIDS. 2017;31:2287-2294.
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