Associations between drug and alcohol use, smoking, and frailty among people with HIV across the United States in the current era of antiretroviral treatment

doi:10.1016/j.drugalcdep.2022.109649

. 2022 Nov 1:240:109649.

doi: 10.1016/j.drugalcdep.2022.109649. Epub 2022 Sep 30.

Associations between drug and alcohol use, smoking, and frailty among people with HIV across the United States in the current era of antiretroviral treatment

Heidi M Crane¹, Stephanie A Ruderman², Bridget M Whitney³, Robin M Nance⁴, Lydia N Drumright⁵, Allison R Webel⁶, Amanda L Willig⁷, Michael S Saag⁸, Katerina Christopoulos⁹, Meredith Greene¹⁰, Andrew W Hahn¹¹, Joseph J Eron¹², Sonia Napravnik¹³, William Christopher Mathews¹⁴, Geetanjali Chander¹⁵, Mary E McCaul¹⁶, Edward R Cachay¹⁷, Kenneth H Mayer¹⁸, Alan Landay¹⁹, Steven Austad²⁰, Jimmy Ma²¹, Stephen B Kritchevsky²², Chintan Pandya²³, Chad Achenbach²⁴, Francisco Cartujano-Barrera²⁵, Mari Kitahata²⁶, Joseph Ac Delaney²⁷, Charles Kamen²⁸; Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) Cohort Study

Affiliations

¹ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: hcrane@uw.edu.
² Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: ruderman@uw.edu.
³ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: bmw05@uw.edu.
⁴ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: rmnance@uw.edu.
⁵ Department of Biobehavioral Nursing and Health Informatics, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: lnd23@uw.edu.
⁶ Department of Child, Family and Population Health Nursing, University of Washington, Health Sciences Building, Box 357260, 1959 NE Pacific Ave, Seattle, WA, USA. Electronic address: awebel@uw.edu.
⁷ Department of Medicine | Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA. Electronic address: awillig@uabmc.edu.
⁸ Department of Medicine | Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA. Electronic address: msaag@uabmc.edu.
⁹ School of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA. Electronic address: katerina.christopoulos@ucsf.edu.
¹⁰ School of Medicine, University of California San Francisco, 490 Illinois Street, San Francisco, CA 94158, USA. Electronic address: Meredith.Greene@ucsf.edu.
¹¹ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: ahahn47@uw.edu.
¹² University of North Carolina, Chapel Hill, CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, USA. Electronic address: joseph_eron@med.unc.edu.
¹³ Department of Epidemiology, 130 Mason Farm Rd, 2101 Bioinformatics Building, Chapel Hill, NC 27599-7215, USA. Electronic address: sonia_napravnik@med.unc.edu.
¹⁴ Owen Clinic, University of California San Diego, UC San Diego Health System, USA. Electronic address: cmathews@health.ucsd.edu.
¹⁵ Department of Medicine, 600N. Wolfe Street, Carnegie, Baltimore, MD 21287, USA. Electronic address: gchande1@jhmi.edu.
¹⁶ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 3400N. Charles St. Baltimore, MD 21218-2683, USA. Electronic address: mmccaul1@jhmi.edu.
¹⁷ Owen Clinic, University of California San Diego, UC San Diego Health System, USA. Electronic address: ecachay@health.ucsd.edu.
¹⁸ Fenway Health/The Fenway Institute, 1340 Boylston Street, Boston, MA 02215, USA. Electronic address: KMayer@fenwayhealth.org.
¹⁹ Rush University, 1735 W. Harrison St, Chicago, IL 60612, USA. Electronic address: Alan_landay@rush.edu.
²⁰ Department of Biology, Campbell Hall, 1300 University Blvd, University of Alabama Birmingham, Birmingham, AL, USA. Electronic address: austad@uab.edu.
²¹ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: jma52@uw.edu.
²² Department of Internal Medicine, Gerontology & Geriatric Medicine, Stricht Center for Healthy Aging and Alzheimer's Prevention, 475 Vine Street, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: skritche@wakehealth.edu.
²³ Center for Population Health Information Technology, Wolfe Street, Baltimore, MD 21205, Johns Hopkins University, Baltimore, MD, USA. Electronic address: pandya2@jhu.edu.
²⁴ Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave # 1, Chicago, IL 60611, USA. Electronic address: c-achenbach@northwestern.edu.
²⁵ Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: Francisco_Cartujano@URMC.Rochester.edu.
²⁶ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: kitahata@uw.edu.
²⁷ College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada. Electronic address: Joseph.Delaney@umanitoba.ca.
²⁸ Department of Surgery University of Rochester Medical Center Rochester, NY, USA. Electronic address: Charles_Kamen@URMC.Rochester.edu.

PMID: 36215811
PMCID: PMC10088427
DOI: 10.1016/j.drugalcdep.2022.109649

Associations between drug and alcohol use, smoking, and frailty among people with HIV across the United States in the current era of antiretroviral treatment

Heidi M Crane et al. Drug Alcohol Depend. 2022.

. 2022 Nov 1:240:109649.

doi: 10.1016/j.drugalcdep.2022.109649. Epub 2022 Sep 30.

Authors

Affiliations

¹ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: hcrane@uw.edu.
² Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: ruderman@uw.edu.
³ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: bmw05@uw.edu.
⁴ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: rmnance@uw.edu.
⁵ Department of Biobehavioral Nursing and Health Informatics, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: lnd23@uw.edu.
⁶ Department of Child, Family and Population Health Nursing, University of Washington, Health Sciences Building, Box 357260, 1959 NE Pacific Ave, Seattle, WA, USA. Electronic address: awebel@uw.edu.
⁷ Department of Medicine | Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA. Electronic address: awillig@uabmc.edu.
⁸ Department of Medicine | Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA. Electronic address: msaag@uabmc.edu.
⁹ School of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA. Electronic address: katerina.christopoulos@ucsf.edu.
¹⁰ School of Medicine, University of California San Francisco, 490 Illinois Street, San Francisco, CA 94158, USA. Electronic address: Meredith.Greene@ucsf.edu.
¹¹ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: ahahn47@uw.edu.
¹² University of North Carolina, Chapel Hill, CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, USA. Electronic address: joseph_eron@med.unc.edu.
¹³ Department of Epidemiology, 130 Mason Farm Rd, 2101 Bioinformatics Building, Chapel Hill, NC 27599-7215, USA. Electronic address: sonia_napravnik@med.unc.edu.
¹⁴ Owen Clinic, University of California San Diego, UC San Diego Health System, USA. Electronic address: cmathews@health.ucsd.edu.
¹⁵ Department of Medicine, 600N. Wolfe Street, Carnegie, Baltimore, MD 21287, USA. Electronic address: gchande1@jhmi.edu.
¹⁶ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 3400N. Charles St. Baltimore, MD 21218-2683, USA. Electronic address: mmccaul1@jhmi.edu.
¹⁷ Owen Clinic, University of California San Diego, UC San Diego Health System, USA. Electronic address: ecachay@health.ucsd.edu.
¹⁸ Fenway Health/The Fenway Institute, 1340 Boylston Street, Boston, MA 02215, USA. Electronic address: KMayer@fenwayhealth.org.
¹⁹ Rush University, 1735 W. Harrison St, Chicago, IL 60612, USA. Electronic address: Alan_landay@rush.edu.
²⁰ Department of Biology, Campbell Hall, 1300 University Blvd, University of Alabama Birmingham, Birmingham, AL, USA. Electronic address: austad@uab.edu.
²¹ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: jma52@uw.edu.
²² Department of Internal Medicine, Gerontology & Geriatric Medicine, Stricht Center for Healthy Aging and Alzheimer's Prevention, 475 Vine Street, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: skritche@wakehealth.edu.
²³ Center for Population Health Information Technology, Wolfe Street, Baltimore, MD 21205, Johns Hopkins University, Baltimore, MD, USA. Electronic address: pandya2@jhu.edu.
²⁴ Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave # 1, Chicago, IL 60611, USA. Electronic address: c-achenbach@northwestern.edu.
²⁵ Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: Francisco_Cartujano@URMC.Rochester.edu.
²⁶ Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA. Electronic address: kitahata@uw.edu.
²⁷ College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada. Electronic address: Joseph.Delaney@umanitoba.ca.
²⁸ Department of Surgery University of Rochester Medical Center Rochester, NY, USA. Electronic address: Charles_Kamen@URMC.Rochester.edu.

PMID: 36215811
PMCID: PMC10088427
DOI: 10.1016/j.drugalcdep.2022.109649

Abstract

Objective: To examine associations between frailty and drug, alcohol, and tobacco use among a large diverse cohort of people with HIV (PWH) in clinical care in the current era.

Methods: PWH at 7 sites across the United States completed clinical assessments of patient-reported measures and outcomes between 2016 and 2019 as part of routine care including drug and alcohol use, smoking, and other domains. Frailty was assessed using 4 of the 5 components of the Fried frailty phenotype and PWH were categorized as not frail, pre-frail, or frail. Associations of substance use with frailty were assessed with multivariate Poisson regression.

Results: Among 9336 PWH, 43% were not frail, 44% were prefrail, and 13% were frail. Frailty was more prevalent among women, older PWH, and those reporting current use of drugs or cigarettes. Current methamphetamine use (1.26: 95% CI 1.07-1.48), current (1.65: 95% CI 1.39-1.97) and former (1.21:95% CI 1.06-1.36) illicit opioid use, and former cocaine/crack use (1.17: 95% CI 1.01-1.35) were associated with greater risk of being frail in adjusted analyses. Current smoking was associated with a 61% higher risk of being frail vs. not frail (1.61: 95% CI 1.41-1.85) in adjusted analyses.

Conclusions: We found a high prevalence of prefrailty and frailty among a nationally distributed cohort of PWH in care. This study identified distinct risk factors that may be associated with frailty among PWH, many of which, such as cigarette smoking and drug use, are potentially modifiable.

Keywords: Alcohol use; Cigarette smoking; Frailty; HIV; Methamphetamine use; Substance use.

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Conflict of interest statement

Conflict of interest All authors report that they have no relevant conflicts of interest to disclose.

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References

1. Ahmed N, Mandel R, Fain MJ, 2007. Frailty: an emerging geriatric syndrome. Am J Med 120(9), 748–753. - PubMed
1. Ainsworth BE, Jacobs DR Jr., Leon AS, 1993. Validity and reliability of self-reported physical activity status: the Lipid Research Clinics questionnaire. Med Sci Sports Exerc 25(1), 92–98. - PubMed
1. Akgun KM, Tate JP, Crothers K, Crystal S, Leaf DA, Womack J, Brown TT, Justice AC, Oursler KK, 2014. An adapted frailty-related phenotype and the VACS index as predictors of hospitalization and mortality in HIV-infected and uninfected individuals. J Acquir Immune Defic Syndr 67(4), 397–404. - PMC - PubMed
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1. Altice FL, Bruce RD, Lucas GM, Lum PJ, Korthuis PT, Flanigan TP, Cunningham CO, Sullivan LE, Vergara-Rodriguez P, Fiellin DA, Cajina A, Botsko M, Nandi V, Gourevitch MN, Finkelstein R, Collaborative B, 2011. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr 56 Suppl 1, S22–32. - PMC - PubMed

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[1] Ahmed N, Mandel R, Fain MJ, 2007. Frailty: an emerging geriatric syndrome. Am J Med 120(9), 748–753. - PubMed

[2] Ahmed N, Mandel R, Fain MJ, 2007. Frailty: an emerging geriatric syndrome. Am J Med 120(9), 748–753. - PubMed

[3] Ainsworth BE, Jacobs DR Jr., Leon AS, 1993. Validity and reliability of self-reported physical activity status: the Lipid Research Clinics questionnaire. Med Sci Sports Exerc 25(1), 92–98. - PubMed

[4] Ainsworth BE, Jacobs DR Jr., Leon AS, 1993. Validity and reliability of self-reported physical activity status: the Lipid Research Clinics questionnaire. Med Sci Sports Exerc 25(1), 92–98. - PubMed

[5] Akgun KM, Tate JP, Crothers K, Crystal S, Leaf DA, Womack J, Brown TT, Justice AC, Oursler KK, 2014. An adapted frailty-related phenotype and the VACS index as predictors of hospitalization and mortality in HIV-infected and uninfected individuals. J Acquir Immune Defic Syndr 67(4), 397–404. - PMC - PubMed

[6] Akgun KM, Tate JP, Crothers K, Crystal S, Leaf DA, Womack J, Brown TT, Justice AC, Oursler KK, 2014. An adapted frailty-related phenotype and the VACS index as predictors of hospitalization and mortality in HIV-infected and uninfected individuals. J Acquir Immune Defic Syndr 67(4), 397–404. - PMC - PubMed

[7] Althoff KN, Jacobson LP, Cranston RD, Detels R, Phair JP, Li X, Margolick JB, Multicenter ACS, 2014. Age, comorbidities, and AIDS predict a frailty phenotype in men who have sex with men. J Gerontol A Biol Sci Med Sci 69(2), 189–198. - PMC - PubMed

[8] Althoff KN, Jacobson LP, Cranston RD, Detels R, Phair JP, Li X, Margolick JB, Multicenter ACS, 2014. Age, comorbidities, and AIDS predict a frailty phenotype in men who have sex with men. J Gerontol A Biol Sci Med Sci 69(2), 189–198. - PMC - PubMed

[9] Altice FL, Bruce RD, Lucas GM, Lum PJ, Korthuis PT, Flanigan TP, Cunningham CO, Sullivan LE, Vergara-Rodriguez P, Fiellin DA, Cajina A, Botsko M, Nandi V, Gourevitch MN, Finkelstein R, Collaborative B, 2011. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr 56 Suppl 1, S22–32. - PMC - PubMed

[10] Altice FL, Bruce RD, Lucas GM, Lum PJ, Korthuis PT, Flanigan TP, Cunningham CO, Sullivan LE, Vergara-Rodriguez P, Fiellin DA, Cajina A, Botsko M, Nandi V, Gourevitch MN, Finkelstein R, Collaborative B, 2011. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr 56 Suppl 1, S22–32. - PMC - PubMed

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Associations between drug and alcohol use, smoking, and frailty among people with HIV across the United States in the current era of antiretroviral treatment

Affiliations

Associations between drug and alcohol use, smoking, and frailty among people with HIV across the United States in the current era of antiretroviral treatment

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Abstract

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