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. 2023 Oct 1;94(2):135-142.
doi: 10.1097/QAI.0000000000003242.

Tobacco Smoking and Pack-Years Are Associated With Frailty Among People With HIV

Stephanie A Ruderman  1 , Michelle C Odden  2 , Allison R Webel  1 , Annette L Fitzpatrick  1 , Paul K Crane  1 , Robin M Nance  1 , Lydia N Drumright  1 , Bridget M Whitney  1 , Lyndsey Sarah Mixson  1 , Jimmy Ma  1 , Amanda L Willig  3 , Lara Haidar  4 , Sherif Eltonsy  4 , Kenneth H Mayer  5 , Conall O'Cleirigh  5 , Karen L Cropsey  3 , Joseph J Eron  6 , Sonia Napravnik  6 , Meredith Greene  7 , Mary McCaul  8 , Geetanjali Chander  1 , Edward Cachay  9 , William B Lober  1 , Stephen B Kritchevsky  10 , Steven Austad  3 , Alan Landay  11 , Chintan Pandya  8 , Francisco Cartujano-Barrera  12 , Michael S Saag  3 , Charles Kamen  12 , Andrew W Hahn  1 , Mari M Kitahata  1 , Joseph A C Delaney  4 , Heidi M Crane  1
Affiliations

Tobacco Smoking and Pack-Years Are Associated With Frailty Among People With HIV

Stephanie A Ruderman et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Tobacco smoking increases frailty risk among the general population and is common among people with HIV (PWH) who experience higher rates of frailty at younger ages than the general population.

Methods: We identified 8608 PWH across 6 Centers for AIDS Research Network of Integrated Clinical Systems sites who completed ≥2 patient-reported outcome assessments, including a frailty phenotype measuring unintentional weight loss, poor mobility, fatigue, and inactivity, and scored 0-4. Smoking was measured as baseline pack-years and time-updated never, former, or current use with cigarettes/day. We used Cox models to associate smoking with risk of incident frailty (score ≥3) and deterioration (frailty score increase by ≥2 points), adjusted for demographics, antiretroviral medication, and time-updated CD4 count.

Results: The mean follow-up of PWH was 5.3 years (median: 5.0), the mean age at baseline was 45 years, 15% were female, and 52% were non-White. At baseline, 60% reported current or former smoking. Current (HR: 1.79; 95% confidence interval: 1.54 to 2.08) and former (HR: 1.31; 95% confidence interval: 1.12 to 1.53) smoking were associated with higher incident frailty risk, as were higher pack-years. Current smoking (among younger PWH) and pack-years, but not former smoking, were associated with higher risk of deterioration.

Conclusions: Among PWH, smoking status and duration are associated with incident and worsening frailty.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.. Distribution of baseline frailty score by baseline smoking status among people with HIV (PWH) by sex and age subgroup in CNICS, 2012–2021.
We graphed the proportion of PWH by their baseline frailty score and baseline smoking status, stratified by the 4 subgroups of interest by age and sex. PWH who reported never smoking had a greater proportion of lower frailty scores than PWH reporting former or current smoking. Additionally, older and female PWH had a greater proportion of higher frailty scores compared to their younger and male counterparts. Abbreviations: Centers for AIDS Research Network of Integrated Clinical Systems, CNICS; people with HIV, PWH
See this image and copyright information in PMC

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