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

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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)135-142
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number2
StatePublished - Oct 1 2023
Externally publishedYes


  • frailty
  • HIV and aging
  • people with HIV
  • tobacco smoking

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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