Evaluating the Sick Quitting Hypothesis for Frailty Status and Reducing Alcohol Use Among People With HIV in a Longitudinal Clinical Cohort Study

Stephanie A. Ruderman, Lydia N. Drumright, Joseph A.C. Delaney, Allison R. Webel, Annette L. Fitzpatrick, Bridget M. Whitney, Robin M. Nance, Andrew W. Hahn, Jimmy Ma, L. Sarah Mixson, Sherif Eltonsy, Amanda L. Willig, Kenneth H. Mayer, Sonia Napravnik, Meredith Greene, Mary McCaul, Edward Cachay, Stephen B. Kritchevsky, Steven N. Austad, Alan LandayMichael S. Saag, Mari M. Kitahata, Bryan Lau, Catherine Lesko, Geetanjali Chander, Heidi M. Crane, Michelle C. Odden

Research output: Contribution to journalArticlepeer-review

Abstract

“Sick quitting,” a phenomenon describing reductions in alcohol consumption following poor health, may explain observations that alcohol appears protective for frailty risk. We examined associations between frailty and reductions in drinking frequency among people with HIV (PWH). At six Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites between January 2012 and August 2021, we assessed whether frailty, measured through validated modified frailty phenotype, precedes reductions in drinking frequency. We associated time-updated frailty with quitting and reducing frequency of any drinking and heavy episodic drinking (HED), adjusted for demographic and clinical characteristics in Cox models. Among 5,654 PWH reporting drinking, 60% reported .monthly drinking and 18% reported $monthly HED. Over an average of 5.4 years, frail PWH had greater probabilities of quitting (HR: 1.56, 95% confidence interval [95% CI] [1.13–2.15]) and reducing (HR: 1.35, 95% CI [1.13–1.62]) drinking frequency, as well as reducing HED frequency (HR: 1.58, 95% CI [1.20–2.09]) versus robust PWH. Sick quitting likely confounds the association between alcohol use and frailty risk, requiring investigation for control.

Original languageEnglish (US)
Pages (from-to)5-16
Number of pages12
JournalJournal of the Association of Nurses in AIDS Care
Volume35
Issue number1
DOIs
StatePublished - Jan 1 2024
Externally publishedYes

Keywords

  • alcohol
  • confounding
  • frailty
  • people with HIV
  • sick quitting

ASJC Scopus subject areas

  • Advanced and Specialized Nursing

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