Tobacco Smoking, Intensity, and Duration Are Associated with Frailty Among People with HIV

Friday, August 26, 2022

2:15 PM – 2:30 PM CEST

Location: C1M0

Publication Number: 52

Background: Tobacco smoking is common among people with HIV (PWH) and has been reported to increase the risk of premature frailty among the general population. PWH experience higher rates of frailty at earlier ages than the general population, but substance use risk factors are under-researched, which limits planning and assessing of effective preventive interventions.

Objectives: To characterize the association between tobacco smoking and frailty among PWH and better understand mechanisms and interventions for healthy aging.

Methods: Between 2012-2021 across 7 Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites, we identified 9,353 PWH who completed at least two patient-reported outcome (PRO) assessments which included frailty items. Frailty was based on a modified Fried's Frailty Phenotype including unintentional weight loss, low mobility, fatigue, and low physical activity. Each of these four items was indicated as present or absent and the phenotype was scored from 0-4, with a total higher score indicating more present components of frailty. Smoking was measured as pack-years at baseline and as time-updated never, former, or current use with intensity (cigarettes smoked per day for those currently smoking, centered at 10 cigarettes/day). We used linear mixed models to estimate associations between smoking (separately for (1) pack-years and (2) tobacco use including intensity) and frailty, adjusted for age, sex, race/ethnicity, time-updated CD4 count, baseline frailty score, site, and years from baseline. We scaled the effects (point estimates and 95% confidence intervals) of smoking relative to the impact of age on frailty to improve interpretability.

Results: Mean follow-up of PWH was 5.2 years (median: 4.7 years). The mean age at baseline was 45 (IQR: 36-53) years, 14% of the cohort was female, 30% were Black, and 48% were white. Sixty percent reported former (28%) or current (32%) smoking at baseline, and a mean of 9 pack-years for those who ever smoked. In adjusted analyses, all measures of smoking were significantly associated with higher frailty scores. The effect per 5 additional pack-years smoking on frailty score was comparable to 18 additional years of age (95% CI: 8-27 years). Similarly, the frailty score for those reporting former smoking was comparable to 24 additional years of age (95% CI: 5-43 years), whereas current smoking was comparable to 39 additional years (95% CI: 18-61 years) and 10 additional cigarettes per day was comparable to 19 additional years of age (95% CI: 2-36 years).

Conclusions: Among PWH, smoking duration and intensity demonstrate an impact on frailty comparable to decades of additional aging. Smoking cessation interventions may help reduce the burden of aging-related conditions, such as frailty, among PWH.

Presenting Author(s)

Stephanie A. Ruderman, MPH

University of Washington
Seattle, Washington, United States

Slides

Co-Author(s)

HC

Heidi Crane

University of Washington, United States
AW

Allison Webel

University of Washington, United States
AF

Annette Fitzpatrick

University of Washington, United States
MO

Michelle Odden

Stanford University, United States
PC

Paul Crane

University of Washington, United States
AW

Amanda Willig

University of Alabama-Birmingham, United States
RN

Robin Nance

University of Washington, United States
LD

Lydia Drumright

University of Washington, United States
BW

Bridget Whitney

University of Washington, United States
JM

Jimmy Ma

University of Washington, United States
LH

Lara Haidar

The University of Manitoba
Winnipeg, Manitoba, Canada
KM

Kenneth Mayer

Harvard University, United States
JE

Joseph Eron

University of North Carolina-Chapel Hill, United States
KC

Katerina Christopoulos

University of California-San Francisco, United States
MG

Meredith Greene

University of California-San Francisco, United States
WM

William Mathews

University of California-San Diego, United States
MS

Michael Saag

University of Alabama-Birmingham, United States
CK

Charles Kamen

University of Rochester, United States
AH

Andrew Hahn

University of Washington, United States
MK

Mari Kitahata

University of Washington, United States
JD

Joseph Delaney, PhD

Associate Professor
College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba
Winnipeg, MB, Canada