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HIV infection is independently associated with frailty in middle-aged HIV type 1 infected individuals compared with similar but uninfected controls..... "HIV-infected individuals were more likely to be frail (10.6 vs. 2.7%)"
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"HIV-infected individuals were more likely to be frail (10.6 vs. 2.7%) and prefrail (50.7 vs. 36.3%) than HIV-uninfected individuals (Ptrend<0.001); this was true for all age-categories"
"This suggests that not only abdominal fat accumulation (of which high waist circumference is an accepted surrogate), but also peripheral lipoatrophy (which may result in a reduced hip-circumference) may contribute to the development of frailty in the context of treated HIV infection."
"We investigated the frailty phenotype in a population of middle-aged HIV-infected individuals, predominantly with undetectable HIV viral load on cART, and similar HIV-uninfected controls. Depression, low BMI and higher WHR were strongly associated with a higher frailty category, but none of the investigated factors could fully explain the observed association between HIV infection, prefrailty, and frailty......Depression may be a consequence of as well as a contributor to frailty......Chronic HCV infection was independently associated with (pre)frailty
HIV-infected individuals were more likely to be frail (10.6 vs. 2.7%) and prefrail (50.7 vs. 36.3%) than HIV-uninfected individuals (Ptrend<0.001); this was true for all age-categories (Fig. 1). All five individual frailty criteria were more often present in HIV-infected than in HIV-uninfected individuals (Fig. 2)....a higher waist-to-hip ratio (WHR) was independently associated with a higher frailty category.....a BMI less than 20 kg/m2 was associated with falling in a higher frailty category in HIV-infected (OR 6.14, 95%CI 3.10-12.18, P < 0.001), but not in HIV-uninfected individuals (OR 0.67......The duration of having had a CD4 cell count less than 200 (OR 1.14/year, 95%CI 1.00-1.30, P1/40.04) as well as the cumulative duration of exposure to protease inhibitors (OR 1.05/year, 95%CI 1.01-1.10, P1/40.01) were independently associated with a higher OR for a higher frailty category......A current BMI less than 20 kg/m2 (OR 2.83, 95%CI 1.26-6.37, P1/40.01), a nadir BMI less than 20 kg/m2 (OR 2.51, 95%CI 1.46-4.31, P1/40.001) and a higher WHR (OR 1.79 per 0.1 higher, 95%CI 1.32-2.41, P < 0.001) were most strongly associated with a higher frailty category in the multivariable model.
Obesity, specifically abdominal obesity, has been recognized as risk factors for the development of frailty in the general population [15,16,26]. Mechanistically, low level systemic inflammation and oxidative stress are hypothesized to be involved [15]. One small study of HIV-infected people, but without controls, showed an association between a high BMI, abdominal obesity and frailty [17]. In the aging HIV-infected population abdominal obesity may partly be due to normal physiological aging and partly from body composition changes due to exposure to HIV and ART, including current regimens [18,27,28]. In our cohort the WHR was more strongly associated with frailty than abdominal obesity, as indicated by waist-circumference, or generalized obesity as indicated by the BMI. Furthermore, a higher WHR appeared to mediate the relation between HIV-infected status and frailty. This suggests that not only abdominal fat accumulation (of which high waist circumference is an accepted surrogate), but also peripheral lipoatrophy (which may result in a reduced hip-circumference) may contribute to the development of frailty in the context of treated HIV infection.
Alternatively, the lower hip-circumference may be related to muscle loss or sarcopenia, an important contributor to frailty [1]."
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