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Risk Factors for Falls, Falls With Injury, and Falls With Fracture Among Older Men With or at Risk of HIV Infection

Erlandson, Kristine M. MD, MSa; Zhang, Long MSb; Ng, Derek K. PhDb; Althoff, Keri N. PhDb; Palella, Frank J. Jr MDc; Kingsley, Lawrence A. DrPHd; Jacobson, Lisa P. ScDb; Margolick, Joseph B. MD, PhDb; Lake, Jordan E. MD, MSce; Brown, Todd T. MD, PhDf

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1, 2019 - Volume 81 - Issue 4 - p e117–e126
doi: 10.1097/QAI.0000000000002074
Clinical Science

Background: Falls and fall risk factors are common among people living with HIV (PLWH). We sought to identify fall risk factors among men with and without HIV.

Methods: Men aged 50–75 years with (n = 279) and without HIV (n = 379) from the Bone Strength Substudy of the Multicenter AIDS Cohort Study were included. Multinomial logistic regression models identified risk factors associated with falling.

Results: One hundred fourteen (41%) PLWH and 149 (39%) of uninfected men had ≥1 fall; 54 (20%) PLWH and 66 (17%) of uninfected men experienced ≥2 falls over 2 years. Five and 3% of PLWH and uninfected men, respectively, had a fall-related fracture (P = 0.34). In multivariate models, the odds of ≥2 falls were greater among men reporting illicit drug use, taking diabetes or depression medications, and with peripheral neuropathy; obesity was associated with a lower risk (all P < 0.05). In models restricted to PLWH, detectable plasma HIV-1 RNA, current use of efavirenz or diabetes medications, illicit drug use, and peripheral neuropathy were associated with greater odds of having ≥2 falls (P < 0.05). Current efavirenz use was associated with increased odds of an injurious fall; longer duration of antiretroviral therapy was protective (both P < 0.05). Greater physical activity was associated with lower risk of falls with fracture (P < 0.05).

Conclusions: Identified risk factors for recurrent falls or fall with fracture included low physical activity, detectable HIV-1 RNA, use of efavirenz, or use of medications to treat diabetes and depression. Fall risk reduction should prioritize interventions targeting modifiable risk factors including increased physical activity, antiretroviral therapy adherence, and transition off efavirenz.

aUniversity of Colorado, Aurora, CO;

bJohns Hopkins Bloomberg School of Public Health, Baltimore, MD;

cNorthwestern University Feinberg School of Medicine, Chicago, IL;

dUniversity of Pittsburgh, Pittsburgh, PA;

eUniversity of Texas Health Science Center, Houston, TX; and

fJohns Hopkins School of Medicine, Baltimore, MD.

Correspondence to: Kristine M. Erlandson, MD, University of Colorado, 12700 E, 19th Avenue, Mail Stop B168, Aurora, CO 80045 (e-mail:

The MACS Bone Strength Substudy (BOSS) was supported by the National Institutes of Health (NIH), under the National Institute of Immunology, Allergy, and Infectious Diseases (NIAID). Support for the MACS is provided by the NIH (UL1 RR0235005, UM1-AI-35043, U01-AI-35039, U01-AI 35040, U01-AI-35041, and U01-A1-35042). Additional support by the National Institute on Aging (R01 AG054366 aThe MACS Bone Strength Substudy (BOSS) was supported0834 to TTB and K23 AI-110532 to JEL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

The authors have no conflicts of interest to disclose.

Received November 06, 2018

Accepted March 27, 2019

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