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Polypharmacy, hazardous alcohol and illicit substance use and serious falls among PLWH and uninfected comparators.

Womack, Julie A. PhD1; Murphy, Terrence E. PhD2; Rentsch, Christopher T. PhD3; Tate, Janet P. MPH, ScD4; Bathulapalli, Harini MS4; Smith, Alexandria C. MSN5; Bates, Jonathan PhD4; Jarad, Samah PhD2; Gibert, Cynthia L. MD6; Rodriguez-Barradas, Maria C. MD7; Tien, Phyllis C. MD8; Yin, Michael T. MD9; Gill, Thomas M. MD2; Friedlaender, Gary MD2; Brandt, Cynthia A. MD, MPH10; Justice, Amy C. MD, PhD10

JAIDS Journal of Acquired Immune Deficiency Syndromes: Month 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002130
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Background. Medication classes, polypharmacy, hazardous alcohol and illicit substance abuse may exhibit stronger associations with serious falls among persons living with HIV (PLWH) than with uninfected comparators. We investigated whether these associations differed by HIV status.

Setting. Veterans Aging Cohort Study

Methods. We employed a nested case-control design. Cases (N=13,530) were those who fell. Falls were identified by external cause of injury codes and a machine learning algorithm applied to radiology reports. These were matched to controls (N=67,060) by age, race, sex, HIV status, duration of observation, and baseline date. Risk factors included medication classes, count of unique non-antiretroviral (non-ART) medications, and hazardous alcohol and illicit substance use. We used unconditional logistic regression to evaluate associations.

Results. Among PLWH, benzodiazepines (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.08, 1.40) and muscle relaxants (OR 1.29; 95% CI 1.08, 1.46) were associated with serious falls but not among uninfected (p>0.05). In both groups, key risk factors included non-ART medications (per five medications) (OR 1.20, 95% CI 1.17, 1.23), illicit substance use/abuse (OR 1.44; 95% CI 1.34, 1.55), hazardous alcohol use (OR 1.30; 95% CI 1.23, 1.37), and an opioid prescription (OR 1.35; 95% CI 1.29, 1.41).

Conclusion. Benzodiazepines and muscle relaxants were associated with serious falls among PLWH. Non-ART medication count, hazardous alcohol and illicit substance use, and opioid prescriptions were associated with serious falls in both groups. Prevention of serious falls should focus on reducing specific classes and absolute number of medications and both alcohol and illicit substance use.

1VA Connecticut Healthcare System and Yale School of Nursing, West Haven, CT

2Yale School of Medicine, New Haven, CT

3VA Connecticut Healthcare System, West Haven, CT and London School of Hygiene & Tropical Medicine, London, UK

4VA Connecticut Healthcare System, West Haven, CT and Yale School of Medicine, New Haven, CT

5Yale School of Nursing, West Haven, CT

6Washington DC Veterans Affairs Medical Center and George Washington University School of Medicine and Health Sciences, Washington, DC

7Michael E DeBakey VA Medical Center, Infectious Diseases Section, and Department of Medicine, Baylor College of Medicine, Houston, TX

8University of California, San Francisco, and Department of Veterans Affairs, San Francisco, CA

9Columbia University Irving Medical Center, New York, NY

10Veterans Affairs Connecticut Healthcare System, West Haven, CT and Yale University Schools of Medicine and Public Health, New Haven, CT

Corresponding author: Julie A. Womack, PhD VA Connecticut Healthcare System 950 Campbell Avenue, Building 35a West Haven, CT 06516 203-687-6430 Fax: 203-937-4926 Julie.womack@yale.edu

This work was supported by: National Institute of Nursing Research [grant number: K01 NR013437]; National Center for Research Resources and National Center for Advancing Translational Sciences [grant number UL1 RR024139]; National Institute on Aging [grant numbers K07 AG043587, P30 AG21342]; National Institute on Alcohol Abuse and Alcoholism [grant numbers U10 AA013566, U24 AA022001].

Conflicts of Interest and Source of Funding: None of the authors declare a conflict of interest.

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