Colorado is regularly impacted by long-range transport of wildfire smoke from upwind regions. This smoke is a major source of ambient PM2.5. Maternal exposure to total PM2.5 during pregnancy has been linked to decreased birth weight and other adverse outcomes, although the impact of wildfire smoke contribution has only recently been investigated. The objective of this study was to estimate associations between adverse pregnancy outcomes and ambient wildfire smoke PM2.5. Wildfire smoke PM2.5 exposures were estimated using a previously published method incorporating ground-based monitors and remote sensing data. Logistic regression models stratified by ZIP code and mixed models with random intercept by ZIP code were used to test for associations. The primary outcomes of interest were preterm birth and birth weight. Secondary outcomes included gestational hypertension, gestational diabetes, neonatal intensive care unit admission, assisted ventilation, small for gestational age, and low birth weight. Exposure to wildfire smoke PM2.5 over the full gestation and during the second trimester were positively associated with pre-term birth (OR = 1.076 (μg/m3)−1 [95% CI = 1.016, 1.139; p = 0.013] and 1.132 (μg/m3)−1 [95% CI = 1.088, 1.178]; p < 0.0001, respectively), while exposure during the first trimester was associated with decreased birth weight (−5.7 g/(μg/m3) [95% CI: −11.1, −0.4; p = 0.036]). Secondary outcomes were mixed.

Objective Both frailty and falls occur at earlier than expected ages among HIV-infected individuals, but the contribution of frailty to fall risk in this population is not well understood. We examined this association among participants enrolled in AIDS Clinical Trials Group (ACTG) A5322. Design A prospective, multi-center cohort study of HIV-infected men and women ≥40 years. Methods Frailty assessment included a 4-meter walk, grip strength, and self-reported weight loss, exhaustion, and low physical activity. Multinomial logistic regression assessed the association between baseline frailty, grip, and 4-meter walk and single and recurrent (2+) falls over the next 12 months; logistic regression assessed effect modification by several factors on association between frailty and any (1+) falls. Results Of 967 individuals, 6% were frail, 39% pre-frail, and 55% non-frail. Eighteen percent had ≥1 fall, and 7% had recurrent falls. In multivariable models, recurrent falls were more likely among frail (OR=17.3; 95% CI=7.03-42.6) and pre-frail (OR=3.80; 95% CI=1.87-7.72) than non-frail individuals. Significant associations were also seen with recurrent falls and slow walk and weak grip. The association between frailty and any falls was substantially stronger among individuals with peripheral neuropathy. Conclusions Aging HIV-infected pre-frail and frail individuals are at significantly increased risk of falls. Incorporation of frailty assessments or simple evaluations of walk speed or grip strength in clinical care may help identify individuals at greatest risk for falls. Peripheral neuropathy further increases fall risk among frail persons, defining a potential target population for closer fall surveillance, prevention, and treatment.

The presence of frailty with NCI was associated with a greater risk of falls, disability or death in PLWH than NCI alone. Interventions that target prevention or reversal of both frailty and NCI (such as increased physical activity) may significantly limit poor health outcomes among PLWH.

Each variable was added separately in the univariate models, and the variables that were found to be significantly associated with hospitalization (P , 0.05) in the univariate models were included in the multivariable models.

Background: Frailty and physical function impairments occur at an earlier than expected age in people with HIV (PWH). The goal of this study was to determine which tools or combination of tools assessing frailty/physical function were most predictive of mortality in a middle-aged population of PWH.Methods: Using electronic health records, we determined survival, death, or loss-to-follow-up for 395 PWH, aged 45-65 originally enrolled in a 2009-2010 cross-sectional cohort study. The predictive accuracy of various physical function measures (frailty score, VACS Index, 400-m walk, SPPB, grip strength, and falls) were compared using integrated time-dependent ROC (ROC-AUC) curves in single variable models. Two-variable models were compared to the best single-variable model to determine if AUC improved with additional physical function variables.Results: At eight-year follow-up, frailty, 400-m walk pace, SPPB, chair rise pace, VACS score, and falls were associated with increased hazard of mortality; grip strength was only predictive in sex-adjusted models. The VACS index and 400-m walk pace were the best individual predictors of mortality with time-dependent ROC-AUC scores of 0.82, followed by SPPB (0.73), chair-rise pace (0.68), falls (0.65), frailty (0.63) and grip strength (0.55). Addition of the 400-m walk to VACS index yielded the only significant improvement in the prediction of survival compared to the VACS index alone (p-value=0.04). Conclusion:Our study highlights several clinically applicable physical function measures predictive of mortality in middle-aged PWH that can be tailored to specific patient sub-populations and clinical or research encounters.

No abstract

Background: The longer-term risks of statins on physical function among people with HIV are unclear. Methods: Longitudinal analysis of Multicenter AIDS Cohort Study men between 40 and 75 years of age with ≥2 measures of gait speed or grip strength. Generalized estimating equations with interaction terms between (1) statin use and age and (2) HIV serostatus, age, and statin use were considered to evaluate associations between statin use and physical function. Models were adjusted for demographics and cardiovascular risk factors. Results: Among 2021 men (1048 with HIV), baseline median age was 52 (interquartile range 46–58) years; 636 were consistent, 398 intermittent, and 987 never statin users. There was a significant interaction between age, statin, and HIV serostatus for gait speed. Among people with HIV, for every 5-year age increase, gait speed (m/s) decline was marginally greater among consistent versus never statin users {−0.008 [95% confidence interval (CI) −0.017 to −0.00007]; P = 0.048}, with more notable differences between intermittent and never users [−0.017 (95% CI −0.027 to −0.008); P < 0.001]. Similar results were observed among men without HIV. Significant differences in grip strength (kg) decline were seen between intermittent and never users [−0.53 (95% CI −0.98 to −0.07); P = 0.024] and differences between consistent and never users [−0.28 (95% CI −0.63 to 0.06); P = 0.11] were not statistically significant. Conclusions: Among men with and without HIV, intermittent statin users had more pronounced declines in physical function compared with consistent and never users. Consistent statin use does not seem to have a major impact on physical function in men with or without HIV.

Objective Evaluate associations between cumulative antiretroviral adherence/exposure, quantified using tenofovir diphosphate (TFV-DP) in dried blood spots (DBS), and HIV-related aging factors. Design Cross-sectional analysis of younger (ages 18–35) and older (ages ≥60) persons with HIV (PWH) taking tenofovir disoproxil fumarate. Methods TFV-DP concentrations were quantified in DBS. Linear and logistic regression models were used to evaluate associations between TFV-DP and bone mineral density (BMD), physical function, frailty, and falls. Results 45 PWH were enrolled (23 younger, 22 older). Every 500 fmol/punch (equivalent to an increase in ~2 doses/week) increase in TFV-DP was associated with decreased hip BMD (-0.021 g/cm 2 [95% CI: -0.040, -0.002], p=0.03). Adjusting for total fat mass, every 500 fmol/punch increase in TFV-DP was associated with higher odds of Short Physical Performance Battery impairment (score ≤10; adjusted OR: 1.6 [95% CI: 1.0, 2.5], p=0.04). Every 500 fmol/punch increase in TFV-DP was associated with slower 400-m walk time (14.8 sec [95% CI: 3.8, 25.8], p=0.01), and remained significant after adjusting for age, lean body mass, body mass index (BMI), and fat mass (all p≤0.01). Every 500 fmol/punch increase in TFV-DP was associated with higher odds of reporting a fall in the prior 6 months (OR: 1.8 [95% CI: 1.1, 2.8], p=0.02); this remained significant after adjusting for age, lean body mass, BMI, total fat mass (all p&lt;0.05). Conclusion Higher TFV-DP levels were associated with lower hip bone mineral density, poorer physical function, and greater risk for falls, a concerning combination for increased fracture risk.