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In Gay Men Over 50, Frailty More Common With HIV Than Without (MACS)
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18th Conference on Retroviruses and Opportunistic Infections, February 27-March 2, 2011, Boston
Mark Mascolini
Among gay men over 50 in the ongoing Multicenter AIDS Cohort Study (MACS), frailty proved significantly more common in antiretroviral-treated men with HIV than in their contemporaries without HIV [1]. MACS investigators suggested this higher frailty rate could indicate "an effect of either HIV infection or [combination antiretroviral therapy], or both, on the risk of frailty and perhaps on the aging process." [from Jules: the contribution of confounders like lifestyle to frailty in HIV including substance abuse history etc is under investigation and should be reported in the future]
Earlier research defined a frailty phenotype marked by having at least three of five conditions: physical shrinking (unintentional weight loss greater than 10 pounds), self-reported exhaustion, low physical activity level (measured by a weighted score of kilocalories expended per week), slowness (time to walk 15 feet), and weakness (grip strength) [2]. MACS researchers validated this definition in gay men with HIV [3]. They planned this new study [1] to determine whether prevalence of frailty phenotype in different age groups differs by HIV status. Because most MACS members with HIV are taking antiretrovirals, the investigators considered only antiretroviral-experienced men in the HIV group of this analysis. MACS physicians rated frailty during study visits in April 2009 and March 2010.
The study group consisted of 1451 HIV-negative gay men and 1307 HIV-positive antiretroviral-treated men. Age averaged 54 in the negative group and 51 in the positive group. Among men with HIV, current CD4 count averaged 567, lowest-ever CD4 count averaged 269, current viral load averaged below 50 copies, and highest-ever viral load averaged 100,000 copies. Racial proportions differed somewhat between the HIV-negative and positive groups, with white men making up the majority in both (72% and 54%) and blacks comprising the second-largest group (19% and 30%).
Prevalence of the frailty phenotype did not differ between men with and without HIV in those under 40 or in those 40 to 49. Among 50-to-59-year-olds, though, prevalence of frailty was higher with HIV than without (14.8% versus 8.1%), and that gap grew among 60-to-69-year-olds (19.9% versus 10%) and over-69-year-olds (33% versus 23%). In the 50-to-59 group and the 60-to-69 group, frailty proved about twice as prevalent with HIV as without HIV (prevalence ratio 1.8, P < 0.01, for 50-to-59; prevalence 2.0, P < 0.01, for 60-to-69). Frailty prevalence ratios for those two age groups also greatly favored the non-HIV group when the MACS investigators limited the HIV group to those with a viral load below 50 copies (prevalence ratio 1.6, P = 0.03, for 50-to-59; prevalence 1.9, P = 0.03, for 60-to-69).
When the MACS team figured frailty prevalence ratios by CD4 bracket in the HIV-positive group, prevalence remained higher with HIV for those with a CD4 count under 200 (prevalence ratio 2.1 versus no HIV, P = 0.01), those with 201 to 350 CD4s (prevalence ratio 1.7 versus no HIV, P = 0.02), and for those with 351 to 500 CD4s (prevalence ratio 1.6 versus no HIV, P = 0.01). But frailty prevalence did not differ between HIV-negative men and HIV-positive men with a CD4 count above 500.
The frailty phenotype was more prevalent in this study than in the earlier MACS analysis [3].
The MACS team called for longitudinal studies to confirm earlier frailty in men with than without HIV and to determine whether the frailty phenotype signals other "adverse outcomes" in HIV-positive people.
References
1. Margolick J, Li X, Detels R, et al. Earlier occurrence of the frailty phenotype in HIV+ men than in HIV- men: the MACS. 18th Conference on Retroviruses and Opportunistic Infections. February 27-March 2, 2011. Boston. Abstract 794.
2. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Med Sci. 2001;56A:M146-M156.
3. Desquilbet L, Jacobson LP, Fried LP, et al. HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. J Gerontol A Biol Sci Med Sci. 2007;62:1279-1286.
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