icon-    folder.gif   Conference Reports for NATAP  
  21st Conference on Retroviruses and
Opportunistic Infections
Boston, MA March 3 - 6, 2014
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Frailty, Inflammation and Mortality among Aging HIV-Infected and At-Risk Injection Drug Users
  Reported by Jules Levin
CROI 2014 March 3-6 Boston, MA
Damani A. Piggott, Ravi Varadhan, Shruti H. Mehta, Todd T. Brown, Sean X. Leng, Gregory D. Kirk Johns Hopkins University, Baltimore, MD, USA
- from jules: frailty is associated with inflammation & inflammation & frailty are associated with mortality in this group in ALIVE cohort, former & current HIV+ & HIV-neg injection drug users. This study found an inflammatory index can predict frailty & mortality & suggest using this index in an aging yet relatively young population of HIV+ and at risk IDUs.
".....measures of inflammation increase with age and have been strongly associated with adverse clinical outcomes among both HIV-infected and uninfected adults. Yet, limited data exists on the potential predictive and clinical utility of aggregate measures of inflammation . Frailty is an age-related syndrome of increased vulnerability to adverse clinical outcomes. Previously, we observed a significant association of frailty with both HIV and mortality risk among aging injection drug users (IDUs). In this study, we evaluated the relationship of frailty with the validated inflammation index and examined the independent effect of this index on mortality.....Frailty was defined in the ALIVE cohort of current and former IDUs by the presence of ≥3 of 5 standard criteria: weakness (grip strength), slow gait speed, weight loss, low physical activity, and exhaustion. An inflammatory index score was constructed from serum measures of interleukin-6 (IL-6) and soluble tumor necrosis factor-α receptor-1 (sTNFR1): (log IL-6 + 2*log sTNFR1)/3. Among 1326 subjects, the median age was 48 years, 88% were African American, 457 (34%) were female, and 387 (29%) were HIV+. [from Jules: 23% had depressive symptoms; 25% had 2 to >3 comorbid conditions, average CD4 count was only 284 (188-444) & viral load was detectable at 3.15 log (1,400 c/ml) (1.60-4.53)]. In separate models, adjusting for sociodemographics, comorbidity, and HIV status, frailty was significantly associated with log IL6 (aOR 1.34; 95% CI, 1.10-1.64), log sTNFR1 (aOR 1.79; 95% CI, 1.11-2.89) and with each unit increase in the inflammatory index score (aOR 2.00; 95% CI, 1.32-3.01). In models adjusting for sociodemographics, comorbidity, HIV and frailty status, the inflammatory index score was independently associated with increased mortality risk (aHR 2.90; 95% CI, 2.18-3.84); for HIV-'s (aHR 2.74; 95% CI 1.88-3.99) and for HIV+'s (aHR 2.55; 95% CI, 1.65-2.95). Similar results were observed adjusting for CD4 count and HIV viral load."