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Frailty Rate in HIV+ mid-50 Women Matches Rate in 70-Year-Olds Without HIV
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6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, July 17-20, 2011, Rome
Mark Mascolini
Objectively measured frailty rates in HIV-positive New York City women in their mid-50s matched rates in 70-year-olds in the general US population, according to results of a small comparative study [1]. Researchers at the Bronx-Lebanon Hospital Center and other centers recorded an 11% frailty prevalence in the HIV group, while no women in the HIV-negative comparison group met frailty criteria.
The researchers described frailty as "a clinical state of vulnerability to stressors, resulting from aging-associated declines in resiliency and physiologic reserves, and a progressive decline in the ability to maintain stable homeostasis." They noted that earlier research recorded a 6% to 12% frailty rate in HIV-positive women with a median age of 40 [2,3]. The investigators defined frailty by the usual method, as presence of three or more of the following five factors:
--Weakness measured by grip strength
--Slow walking speed
--Low physical activity
--Unintentional weight loss
--Self-reported exhaustion
The study compared 36 postmenopausal women with HIV and 26 postmenopausal women without HIV. HIV-positive women were younger than HIV-negative women (average 56 versus 59 years, P = 0.03), and the HIV group tended to weigh less (average 71 versus 79 kg, P = 0.08). All women in both groups were Hispanic or African American, and ethnicity rates were similar in the two groups (60% Hispanic, 40% African American).
The groups were also similar in average years since menopause (1.3 with HIV and 1.2 without HIV), proportion of current smokers (21% and 15%, P = 0.74), proportion who had more than 1 alcoholic drink daily (18% and 4%, P = 0.12), and proportion who were HCV seropositive (21% and 7%, P = 0.28). Nor did the groups differ in four hormone or cytokine levels: estrone, 25-OHD, TNF-alpha, and interleukin 6.
Women with HIV were diagnosed an average 8.9 years earlier, and half had AIDS. Twenty-eight HIV-positive women (78%) were taking antiretrovirals, with 16 on a protease inhibitor and 8 on a nonnucleoside. Average current and nadir (lowest-ever) CD4 counts were 465 and 263.
Average total lean mass was virtually identical in the two groups (45.1 and 45.0 kg), as was average appendicular mass (19.4 and 19.8 kg). The groups were also similar in fat mass (27.6 and 32.1 kg, P = 0.14) and truncal fat mass (13.9 and 15.9 kg, P = 0.17). The HIV group was leaner by two measures: percent body fat (36.7% versus 40.9%, P = 0.03) and percent truncal fat (37.3% versus 42.0%, P = 0.02).
Four of the five frailty factors were more prevalent in women with HIV than in the HIV-negative group: weight loss (18% versus 4%), low energy expenditure (3% versus 0%), grip strength weakness (33% versus 23%), and exhaustion (25% versus 7%). None of these differences reached statistical significance, though there was a trend toward higher exhaustion prevalence in the HIV group (P = 0.09). In an analysis adjusted for age and body mass index, grip strength was significantly lower in women with HIV (22.3 +/- 1 kg versus 25.2 +/- 1.5 kg, P = 0.015).
A nonsignificantly higher proportion of HIV-negative women were slow on the walking test (30% versus 25%, P = 0.78).
Overall, 4 HIV-positive women (11%) and no HIV-negative women could be classified as frail because they met three or more of these criteria, but that difference stopped short of statistical significance (P = 0.12).
To pinpoint predictors of frailty, the investigators divided the HIV group into 19 prefrail or frail women (prefrail women met one or two criteria) and 15 robust women (with no frailty markers). In this analysis, higher body mass index and higher total fat distinguished frail and prefrail women from robust women:
For body mass index:
31.3 +/- 1.9 kg/m(2) for the prefrail/frail group and 26.3 +/- 0.8 kg/m(2) for the robust group, P = 0.03
For total fat:
30.1 +/- 3.7 kg in prefrail/frail group and 22.8 +/- 1.0 kg in robust group, P = 0.04
HCV positivity was more prevalent in the prefrail/frail group than in the robust group (32% versus 7%), but this difference stopped short of statistical significance (P = 0.10).
The researchers noted that frailty prevalence in this group mirrored the 11% to 12% rate reported in postmenopausal women with a median age of 70 in the general US population [4]. They observed that their results run counter to earlier studies that correlate lower weight with frailty, perhaps because most of the women they studied are overweight or obese and have good HIV control with antiretroviral therapy.
The investigators called for further study with a larger sample and "more challenging muscle strength and functional performance measures," which they believe may disclose subtle differences in frailty measures between HIV-positive and negative women.
References
1. Ferris D, Zhang C, Dam T, et al. Early frailty in postmenopausal women with human immunodeficiency virus (HIV) infection. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. July 17-20, 2011. Rome. Abstract TUPE129.
2. Terzian AS, Holman S, Nathwani N, et al; Women's Interagency HIV Study. Factors associated with preclinical disability and frailty among HIV-infected and HIV-uninfected women in the era of cART. J Womens Health (Larchmt). 2009;18:1965-1974.
3. Onen NF, Agbebi A, Shacham E, Stamm KE, Onen AR, Overton ET. Frailty among HIV-infected persons in an urban outpatient care setting. J Infect. 2009;59:346-352.
4. Bandeen-Roche K, Xue QL, Ferrucci L, et al. Phenotype of frailty: characterization in the women's health and aging studies. J Gerontol A Biol Sci Med Sci. 2006;61:262-266.
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