Background The incidence of and risk factors for falls in human immunodeficiency (HIV)-1-infected persons are unknown. Methods Fall history during the prior 12 months, medical diagnoses, and functional assessments were collected on HIV-infected persons 45 to 65 years of age receiving effective antiretroviral therapy. Fall risk was evaluated using univariate and multivariate regression analyses. Results Of 359 subjects, 250 persons (70%) reported no falls, 109 (30%) had ≥1 fall; 66 (18%) were recurrent fallers. Females, Caucasians, and smokers were more like to be recurrent fallers (p≤0.05). HIV-related characteristics including current and nadir CD4 T-cell count, estimated HIV duration, and Veterans Aging Cohort Study Index scores were not predictors of falls (all p≥0.09); didanosine recipients were more likely to be recurrent fallers (p=0.04). The odds of falling increased 1.7 for each comorbidity and 1.4 for each medication (p<0.001), and were higher in persons with cardiovascular disease, hypertension, dementia, neuropathy, arthritis, chronic pain, psychiatric disease, frailty or disability (all OR≥ 1.8; p≤0.05). Beta-blockers, antidepressants, anti-psychotics, sedatives, and opiates were independently associated with falling (all OR ≥2.7; p≤0.01). Female gender, diabetes, antidepressants, sedatives, opiates, didanosine, exhaustion, weight loss, and difficulty with balance were the most significant predictors of falls in logistic regression (all OR ≥2.5; p≤0.05). Conclusion Middle-aged HIV-infected adults have high fall risk. Multiple comorbidities, medications, and functional impairment were predictive of falls, but surrogate markers of HIV infection or an HIV-specific multimorbidity index were not. Fall risk should be assessed routinely as part the care of HIV-infected persons.

Despite more favorable clinical parameters initially, female HIV-1-seroconverters had worse outcomes than did male seroconverters. Elevated morbidity was associated with being nonwhite and residing in the southern United States.

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Nearly 70% of Colorado cannabis dispensaries contacted recommended cannabis products to treat nausea in the first trimester. Few dispensaries encouraged discussion with a health care provider without prompting. As cannabis legalization expands, policy and education efforts should involve dispensaries.

Functional impairment during successful antiretroviral therapy was associated with higher CD8(+) T-cell activation and interleukin 6 levels. Interventions to decrease immune activation and inflammation should be evaluated for their effects on physical function and frailty.

Objective To ascertain demographic and clinical characteristics of maternal deaths from self-harm (accidental overdose or suicide) in order to identify opportunities for prevention. Methods We report a case series of pregnancy-associated deaths due to self-harm in the state of Colorado between 2004 and 2012. Self-harm deaths were identified from several sources, including death certificates. Birth and death certificates along with coroner, prenatal care and delivery hospitalization records were abstracted. Descriptive analyses were performed. For context, we describe demographic characteristics of women with a maternal death from self-harm and all women with live births in Colorado. Results Among the 211 total maternal deaths in Colorado over the study interval, 30% (n=63) resulted from self-harm. The pregnancy-associated death ratio from overdose was 5.0 (95% CI 3.4, 7.2) per 100,000 live births and from suicide 4.6 (95% CI 3.0, 6.6) per 100,000 live births. Detailed records were obtained for 94% (n=59) of women with deaths from self-harm. Deaths were equally distributed throughout the first postpartum year (mean 6.21 ± 3.3 months postpartum) with only 6 maternal deaths during pregnancy. Seventeen percent (n=10) had a known substance use disorder. Prior psychiatric diagnoses were documented in 54% (n=32) and prior suicide attempts in 10% (n=6). While half (n=27) of the women with deaths from self-harm were noted to be taking psycho-pharmacotherapy at conception, 48% of them discontinued the medications during pregnancy. Fifty women had toxicology testing available; pharmaceutical opioids were the most common drug identified (n=21). Conclusion Self-harm was the most common cause of pregnancy-associated mortality with most deaths occurring in the postpartum period. A four-pronged educational and program building effort to include women, providers, health care systems, and both governments and organizations at the community and national level may allow for a reduction in maternal deaths.

Background Disability and frailty are associated with osteoporosis, obesity, and sarcopenia. HIV-infected persons have early functional impairment, but the association between body composition and functional impairment is unknown. Methods HIV-1-infected participants on combination antiretroviral therapy with virologic suppression, aged 45–65 years, had standardized physical function measures. In a nested analysis, 30 low- and 48 high-functioning cases and controls were matched by age, gender, and time since HIV diagnosis. Bone mineral density, fat mass, and lean body mass (LBM) were assessed by dual-energy X-ray absorptiometry. Odds ratios (OR) with 95% confidence intervals were obtained from conditional logistic regression. Results Mean age was 53 years, mean CD4+ lymphocytes 598 cells/μL, and 96% had plasma HIV-1 RNA <50 copies/mL. Low- and high-function subjects had similar CD4+lymphocyte count and duration and type of antiretroviral therapy. Lower T-scores at the hip (OR 3.8 [1.1, 12.5]) and lumbar spine (OR 2.3 [1.1, 4.5]) and lower LBM (OR 1.1 [1.0, 1.2]) were associated with significantly greater odds of low function (p≤0.03). Lower insulin-like growth hormone (IGF-1: OR 5.0 [1.4, 20.0]) and IGF-1 binding protein 3 (OR 3.3 [1.7, 9.9]) increased the odds of low functional status (p≤0.02). Fat mass and lower 25-OH vitamin D did not increase the odds of low functional status (p>0.05). Conclusions Functional impairment in HIV-1-infected persons on successful antiretroviral therapy is associated with low muscle mass, low bone mineral density and low IGF-1 and IGFBP-3. These characteristics may be a manifestation of early “somatopause” in middle-aged HIV-infected adults.

Background The NICHD Stillbirth Collaborative Research Network (SCRN) previously demonstrated an association between stillbirth and maternal marijuana use as defined by the presence of 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC) in the umbilical cord homogenate. However, the relationship between marijuana use and perinatal complications in live births is uncertain. Objective Our aim was to examine if maternal marijuana use is associated with increased odds of adverse pregnancy outcomes and neonatal morbidity among liveborn controls in the SCRN cohort. Study Design Secondary analysis of singleton, liveborn controls in the SCRN dataset. Marijuana use was measured by self-report and/or the presence of THC in umbilical cord homogenate. Tobacco use was measured by self-report and/or presence of any cotinine in maternal serum. Adverse pregnancy outcome was a composite of small for gestational age (SGA), spontaneous preterm birth resulting from preterm labor with or without intact membranes (SPTB), and hypertensive disorders of pregnancy (HTN). Neonatal morbidity included neonatal intensive care unit (NICU) admission and composite neonatal morbidity (pulmonary morbidity, necrotizing enterocolitis, seizures, retinopathy of prematurity, infection morbidity, anemia requiring blood transfusion, neonatal surgery, hyperbilirubinemia, neurological morbidity or death prior to hospital discharge). Effect of maternal marijuana use on the probability of an adverse outcome was estimated using weighted methodology to account for over-sampling in the original study. THC cord homogenate analysis was performed in the subset of women for whom biospecimens were available. Comparisons using logistic modeling, chi-square, and t-tests were weighted to account for oversampling of preterm births and non-Hispanic blacks. Results are reported as weighted percent and unweighted frequencies. Results Maternal marijuana use was identified in 2.7% (unweighted frequency 48/1610) of live births. Use was self-reported by 1.6% (34/1610) and detected by THC in cord homogenate for 1.9% (17/897), n=3 overlapping. Rate of tobacco use was 12.9% (217/1610), with 10.7% (167/1607) by self-report and 9.5% (141/1313) by serum cotinine. The composite adverse pregnancy outcome was not significantly increased in women with marijuana use compared to non-users (31.2% versus 21.2%, p=0.14). After adjustment for tobacco, clinical and socioeconomic factors, marijuana use was not associated with the composite adverse pregnancy outcome (aOR 1.29, 95% CI 0.56–2.96). Similarly, among women with umbilical cord homogenate and serum cotinine data (n=765), marijuana use was not associated with adverse pregnancy outcomes (aOR 1.02, 95% CI 0.18–5.66). NICU admission rates were not statistically different between groups (16.9% users versus 9.5% non-users, p=0.12). Composite neonatal morbidity or death was more frequent among neonates of mothers with marijuana use compared to non-users (14.1% versus 4.5%, p=0.002). In univariate comparisons, the components of...