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Frailty, "Precarious" Status, and Comorbidities Linked in Large French Cohort
  6th International Workshop on HIV and Aging
October 5-6, 2015, Washington, DC
Mark Mascolini
Two thirds of an older French HIV group met criteria for frailty or prefrailty, and half met criteria for "precarious" socioeconomic status in a 509-person prospective analysis [1]. Multivariate analysis linked frailty and 2 or more comorbidities to precariousness, defined by the EPICES (Evaluation of Deprivation and Inequalities in Health Examination Centers) score [2].
This 18-month prospective study involved HIV-positive people 50 or older seen in 2013 and 2014 at 12 HIV-dedicated hospital medical units across southeastern France. Participants completed a questionnaire in which they reported 2 of 5 frailty criteria (weight loss and activity level), 11 components of the EPICES score, and treatment. Their physicians reported 3 frailty criteria (grip strength, walking time, and energy on a visual analog scale) and data on HIV infection and comorbidities. The comorbidities considered were cancer, HBV/HCV, diabetes, dyslipidemia, hypertension, lipodystrophy, pulmonary diseases, chronic kidney disease, cardiovascular disease, psychiatric disorders, and bone and joint disease.
People who meet 3 or more of the Fried frailty criteria are classified as frail, those who meet 1 or 2 criteria are prefrail, and those who meet none are not frail. The EPICES score, validated in 58 French centers, combines answers to questions about social benefit, health insurance, family structure, income, financial difficulties, leisure activities, and social support. On a scale of 0 to 100, a score of 30.17 indicates precarious socioeconomic circumstances. Recent research linked an EPICES score above 30.17 to a detectable HIV load [3].
The new study included 509 people, 370 of them (73%) men. Median age stood at 56.6 (interquartile range [IQR] 52.4 to 62.6), and 186 people (37%) were 60 or older. Participants had been infected with HIV for a median of 20 years (IQR 13 to 25), and 22% had clinical AIDS. Most study group members (60%) had normal body mass index, 4% were underweight, 27% overweight, and 8% obese.
Dyslipidemia proved the most frequent comorbidity (36.7%), followed by lipodystrophy (30.5%), hepatitis B or C (26.1%), psychiatric disorders (25.7%), bone or joint disease (22.5%), and hypertension (22.2%). Most study participants (59.6%) had 2 or more comorbidities, and 37.3% had 3 or more.
Thirty-two people (6.3%) met frailty criteria, 291 (57%) were prefrail, and 242 (47.5%) had an EPICES-defined precarious status. A precarious state proved more frequent in women than men (57.8% versus 45.4%, P = 0.014), in people with longer HIV infection (average 19.8 versus 17.7 years, P = 0.011), in those with a latest CD4 count below 350 (61.9% versus 47%, P = 0.027), and in those with 3 or more comorbidities (56.6% versus 44.7%, P = 0.011). While 22 of 32 frail people (69%) had a precarious socioeconomic status, 218 of 458 nonfrail people (48%) were precarious (P = 0.010). More than two thirds of frail people (78.1%) had 2 or more comorbidities, and 59.4% had an abnormal body mass index.
Multivariate analysis identified four independent predictors of a precarious state: female sex (P = 0.021), latest CD4 count below 350 (P = 0.049), 2 or more comorbidities (P = 0.001), and frailty (P = 0.048).
The researchers concluded that about two thirds of their study group were frail or prefrail and about half had a precarious socioeconomic status. Preventing Fried-defined frailty should be a priority in aging HIV-positive people, they argued, because frailty has been linked to morbidity, mortality, and loss of autonomy.
1. Enel P, Retornaz F, Petit N, et al. HIV-infected aging patients: which relationship between precarity, frailty and comorbidity? 6th International Workshop on HIV and Aging. October 5-6, 2015, Washington, DC. Abstract 5.
2. Labbe E, Blanquet M, Gerbaud L, et al. A new reliable index to measure individual deprivation: the EPICES score. Eur J Pub Health. Published online January 26, 2015. http://eurpub.oxfordjournals.org/content/early/2015/01/25/eurpub.cku231
3. Abgrall S, Raho-Moussa M, Honore P, et al. Impact of socioeconomic status on virologic response to combination antiretroviral therapy (cART). ICAAC 2015, September 17-21, 2015, San Diego. Abstract H-1228.