Falls are common among middle-aged people with HIV, US investigators report in the online edition of the Journal of Acquired Immune Deficiency
Syndromes. Over twelve months, almost a third of people in the study (30%) experienced
“We found that the fall rate in middle-aged
adults…with HIV-1 infection, is as common as in uninfected persons aged 65 years
or older,” comment the authors. “Falls in our cohort were associated with
several previously reported risk factors such as hypertension, diabetes,
impaired balance, and pain, as well as medications used in the treatment of
Falls are common among older adults,
occurring in a third of over-65s each year. They are a frequent cause of
emergency hospital admission and can result in loss of independence.
HIV infection appears to be a risk factor
for a number of diseases of ageing. Moreover, there is also a high prevalence
of traditional risk factors for falls such as diabetes, pain, depression,
neuropathy and use of psychoactive medications among people living with HIV.
“We hypothesized that a greater number of
fall risk factors would result in a higher than expected fall rate among
middle-aged HIV-1-infected adults,” write the investigators.
They therefore designed a study involving 359 people who received care in Colorado between early 2009 and early 2010. All were aged between 45 and 65 and were taking antiretroviral therapy
with an undetectable or low viral load (at least one undetectable measurement
and no measurement above 200 copies/ml).
Most of the study participants (85%) were men, 74%
were white, 65% were gay men and 21% had a history of injecting drug use. The
mean age was 52 years, mean CD4 cell count was 594 cells/mm3 and 95%
had an undetectable viral load.
A total of 109 people (30%) reported at
least one fall in the previous year. Almost two-thirds (61%) of those
experiencing a fall had multiple falls. Women and smokers were more likely to
have recurrent falls (p < 0.05).
The investigators believe these figures
underestimate the incidence of falls in people with HIV who are doing
less well on antiretroviral therapy, as well as those “with advanced
immunodeficiency, or with greater intravenous drug abuse.”
No HIV-related factor was associated with
an increased risk of fall. Analysis failed to find any association with either
nadir and current CD4 cell count or viral load. There was a weak association
with longer duration of HIV infection, but this failed to reach significance.
However, the presence of other health
problems did increase the risk of falls. Each additional co-morbidity increased
the risk of falling by 70% (OR = 1.7; 95% CI, 1.5-2.1, p < 0.001).
Use of medication was also associated with
the risk of falling. Each additional medication increased the risk of falls by
40% (OR = 1.4; 95% CI, 1.3-1.6, p < 0.001). Medications associated with a
risk of falling included beta-blockers, antidepressants, sedatives and opiates
(p < 0.01). The investigators also found evidence of an association
with falls and the older anti-HIV drugs d4T (stavudine, Zerit) and ddI (didanosine,
Videx). A recognised side-effect of these drugs is neuropathy, a known risk
factor for falls.
Frailty and disability were also associated
with an increased risk of falls (p < 0.001). In addition, people who had recurrent falls
had a significantly slower walking pace compared to people who didn't fall (p < 0.001).
After controlling for potential
confounders, the researchers found that a number of factors were associated
with falls. These included female gender, diabetes, antidepressants, treatment
with sedatives, opiates, HIV therapy that included ddI, exhaustion, weight loss
and difficulty with balance. All more than doubled the risk of falls (p <
“Ultimately, the best predictors of fall
risk were those factors known to be associated with fall risk in geriatric
populations,” write the investigators.
“Given that multiple factors lead to
increased fall risk, it is expected that successful interventions to reduce
falls in HIV-infected persons will require a multipronged approach including
medication adjustment, behavioural modifications, vitamin D supplementation,
physical therapy, and exercise or balance programmes,” the authors suggest.
They recommend “providers caring for
HIV-infected persons should routinely inquire about falls, assess fall risk
factors for those at risk for falling, and when high risk is identified,
intervene to reduce risk.”