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  Second International Workshop
on HIV and Aging
October 27-28, 2011
Baltimore, MD
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Falling Rate Similar in 45-to-65-Year-Olds With HIV and HIV-Negatives Over 65
  2nd International Workshop on HIV and Aging, October 27-28, 2011, Baltimore, Maryland

Mark Mascolini

HIV-positive people from 45 to 65 years old and averaging 52 fell as frequently as people 65 or older in the general US population, according to results of a 359-person cross-sectional study [1]. Several measures of weakness and multiple common morbidities independently raised the risk of falling frequently in this study from the University of Colorado.

In the United States about 30% of people 65 or older fall every year. Because of concerns about accelerated aging in people with HIV, falls may be more frequent in the HIV population. Three studies found higher fragility fracture rates in HIV-positive people than in control populations [2-4]. Among premenopausal women in the US Women's Interagency HIV Study, fracture rates did not differ between women with and without HIV [5]. But little research has addressed the incidence and risk factors for falling in people with HIV.

The University of Colorado study focused on 45- to 65-year-old people taking antiretroviral therapy for more than 6 months and reaching a viral load below 48 copies at least once. No one had a recorded viral load above 200 copies after attaining an undetectable level. Researchers questioned study participants about falls in the prior year, performed physical exams, and checked medical records for relevant diagnoses and medications. The investigators defined frequent fallers as people with two or more falls in the past year.

The study group averaged 52 years in age and included few injection drug users or heavy alcohol users. Of the 359 people studied, 250 (70%) reported no falls, 109 (30%) fell at least once, 43 (12%) fell once, and 66 (18%) fell two or more times in the past year. Thus risk of falling in this middle-aged HIV-positive group was similar to that recorded in HIV-negative people 65 and older.

Frequent fallers and nonfallers were similar in age (average 52.4 +/- 0.3 and 52.0 +/- 0.6 years), current CD4 count (599 and 595), nadir CD4 count (163 and 168), and duration of continuous antiretroviral therapy (101 and 98 months). Compared with nonfallers, frequent fallers had a doubled risk of lipoatrophy (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.1 to 3.7, P = 0.02) and a nonsignificantly longer time since HIV diagnosis (15.8 versus 14.0 years in nonfallers, P = 0.09).

In univariate analysis, female gender, smoking, and an array of comorbid conditions raised the risk of frequent falls at the following odds ratios (and 95% CIs) (for all P < 0.01).

-- Females gender: OR 2.5 (1.3 to 4.8)
-- Smoking: OR 2.1 (1.2 to 3.4)
-- Diabetes: OR 5.6 (2.6 to 12.1)
-- Psychiatric disease: OR 3.7 (1.9 to 6.9)
-- Cardiovascular disease: OR 3.0 (1.4 to 6.8)
-- Arthritis: OR 3.2 (1.5 to 5.5)
-- Chronic pain: OR 4.6 (2.6 to 8.2)
-- Neuropathy: OR 3.2 (1.8 to 5.6)
-- Dementia: OR 8.2 (2.0 to 33.9)

Each additional medication raised the risk of frequent falls 40%. Use of several medications (all related to the preceding comorbidities) also raised the risk of frequent falls in univariate analysis (for all P < 0.01):

-- Beta blockers: OR 3.6 (1.8 to 7.3)
-- Diabetes medications: OR 4.5 (2.0 to 10.2)
-- Antidepressants: OR 4.6 (2.6 to 8.1)
-- Antipsychotics: OR 3.9 (1.9 to 8.1)
-- Benzodiazepines: OR 2.8 (1.4 to 5.3)
-- Narcotic pain medications: OR 5.5 (3.1 to 9.8)

Several measures of strength or weakness distinguished frequent fallers from nonfallers. Compared with nonfallers, frequent fallers had weaker grip strength (OR 4.7, 95% CI 2.2 to 10.0, P < 0.001), greater difficulty rising from a chair (OR 2.6, 95% CI 1.3 to 5.3, P = 0.006), greater difficulty with balance (OR 13.7, 95% CI 4.2 to 44.0, P < 0.001), and slower gait speed on a 400-meter walk (1.5 m/sec versus 1.3 m/sec, P < 0.001). The researchers noted that the balance test, in which a person stands with one foot heel-to-toe in front of the other, is simple to perform and had a high predictive value.

People who met frailty criteria by Fried's definition had more than a 9 times higher risk of falling frequently than did nonfrail people in univariate analysis (OR 9.3, 95% CI 3.6 to 24.3, P < 0.001).

The University of Colorado team cautioned that the study is limited by its cross-sectional design and its reliance on recall for falls. Because participants came from a single center and included few injection drug users or heavy alcohol users, the results may not apply to those groups.

The researchers suggested that "fall risk should be assessed routinely in middle-aged HIV-1-infected persons and the effectiveness of interventions to prevent falls in HIV-infected persons should be explored."


1. Erlandson KM, Allshouse AA, Jankowski C, et al. Prevalence of and risk factors for frequent falls in HIV-1 infected persons. 2nd International Workshop on HIV and Aging. October 27-28, 2011. Baltimore, Maryland. Abstract O_05.

2. Young B, Dao CN, Buchacz K, Baker R, Brooks JT; HIV Outpatient Study (HOPS) Investigators. Increased rates of bone fracture among HIV-infected persons in the HIV Outpatient Study (HOPS) compared with the US general population, 2000-2006. Clin Infect Dis. 2011;52:1061-1068.

3. Womack JA, Goulet JL, Gibert C, et al; Veterans Aging Cohort Study Project Team. Increased risk of fragility fractures among HIV infected compared to uninfected male veterans. PLoS One. 2011;6:e17217.

4. Triant VA, Brown TT, Lee H, Grinspoon SK. Fracture prevalence among human immunodeficiency virus (HIV)-infected versus non-HIV-infected patients in a large U.S. healthcare system. J Clin Endocrinol Metab. 2008;93:3499-3504.

5. Yin MT, Shi Q, Hoover DR, Anastos K, et al. Fracture incidence in HIV-infected women: results from the Women's Interagency HIV Study. AIDS. 2010;24:2679-2686.