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Comorbidities Are Key Frailty Risk Factors in Older French Group With HIV
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10th International Workshop on HIV and Aging, October 10-11, 2019, New York
Mark Mascolini
Comorbidities in aging people with HIV--notably cancer, osteoarthritis, psychiatric disease, and falls--emerged as the main independent predictors of frailty in a French group at least 50 years old [1]. The sole HIV-related independent predictor of frailty was nadir CD4 count below 200, which lowered chances of frailty.
Frailty defined by standard Fried criteria [2] has gained increasing attention in studies of people with HIV. People with 3 or more of 5 criteria are classified as frail: unintentional weight loss (10 pounds in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. Fulfilling 1 or 2 of the 5 criteria indicates prefrailty. French investigators who conducted a new multicenter study believe that frailty indicates "a decreased capacity to manage adverse outcomes (disease, hospitalization, disability, falls, trauma)."
The French team conducted a cross-sectional analysis to estimate frailty prevalence in people with HIV and to define independent predictors of frailty with HIV. From November 2012 through April 2014, they assessed HIV-positive people at least 50 years old at 12 HIV hospital units in the south of France. For each participant, researchers tabulated demographic data, HIV-related parameters (including HIV duration, CD4 count, nadir CD4 count, and viral suppression), and general health parameters (including body mass index [BMI], HIV-related comorbidities, and pain).
The study involved 509 people with HIV, 72% of them men, and 86% with an undetectable viral load. Age averaged 56.6 years; the group had been diagnosed with HIV infection for an average 19.7 years and had taken antiretroviral therapy for an average 15.7 years.
While 60% of study participants used tobacco, 23% used illicit drugs. Almost 11% reported a fall in the past 6 months, and 38.5% stood at risk for depression according to the Mini GDS Geriatric Depression Scale. While 59.5% of participants had 2 or more comorbidities, 38% had 3 or more comorbidities.
Frailty prevalence stood at 8.1% and prefrailty prevalence at 58%. Univariate analysis saw no association between most demographic and HIV-related factors and frailty. Multivariate analysis including variables with an association of at least P < 0.15 in the univariate model identified several independent predictors of frailty in these older people with HIV, at the following odds ratios (OR) and 95% confidence intervals (CI):
-- Cancer history: OR 4.92 (95% CI 1.61 to 15.03), P = 0.005
-- Tobacco use: OR 3.98 (95% CI 1.37 to 11.52), P = 0.011
-- Falls: OR 3.01 (95% CI 1.09 to 8.33), P = 0.034
-- Osteoarthritis: OR 2.87 (95% CI 1.05 to 7.84) P = 0.040
-- Psychiatric disease: OR 2.80 (95% CI 1.03 to 7.62), P = 0.044
-- Higher pain scale: OR 1.25 (95% CI 1.07 to 1.46), P = 0.004
-- BMI above 25 kg/m2: OR 1.22 (95% CI 1.12 to 1.34), P = 10(-3)
-- Nadir CD4 count below 200 lowered chances of frailty: OR 0.29 (95% CI 0.12 to 0.74), P = 0.010), perhaps because of closer follow-up of these patients.
Six factors were not significantly associated with frailty:
-- Male sex: OR 0.65 (95% CI 0.24 to 1.73), P = 0.38
-- HIV duration 25 or more years: OR 1.68 (95% CI 0.66 to 4.26), P = 0.28
-- EPICES* score: OR 1.02 (95% CI 0.99 to 1.037), P = 0.07
-- Kidney disease history: OR 2.87 (95% CI 0.75 to 11.04), P = 0.12
-- Lipodystrophy: OR 1.48 (95% CI 0.50 to 4.35), P = 0.48
-- Total number of comorbidities: OR 0.73 (95% CI 0.49 to 1.085), P = 0.12
*Evaluation of Deprivation and Inequalities in Health Examination Centers.
The French researchers believe their findings strongly implicate comorbidities as the principal factors driving frailty in older virologically suppressed people with HIV infection. Their analysis implicated three comorbidities--cancer, osteoarthritis, and psychiatric disease. Another strong predictor, tobacco use, causes numerous comorbidities. The French team proposed that a brittle state "precedes polypathology or disabilities and undermines one's capacity to fight against physical or mental assaults." The investigators urged colleagues to focus on preventing comorbidities, especially in people with a cancer history, to delay frailty.
References
1. Psomas C, Petit N, Ravaux I, et al. Frailty phenotype in older virologically suppressed PLWHIV is strongly correlated with specific comorbidities and tobacco use. 10th International Workshop on HIV and Aging, October 10-11, 2019, New York. Abstract 9.
2. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-M156.
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