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AIDS, Depression, Diabetes, Kidney Disease Predict Frailty in HIV-Positive Gays: frailty double in HIV+ MSM in MACS
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3rd International Workshop on HIV and Aging, November 5-6, 2012, Baltimore
Mark Mascolini
Frailty proved significantly more likely in 50- to 64-year-old men with HIV than without HIV, according to results of a Multicenter AIDS Cohort Study (MACS) analysis [1]. Among men with HIV, a history of AIDS, depressive symptoms, diabetes, kidney disease, and hepatitis C virus infection predicted progression to frailty during the study period.
As people with HIV live longer thanks to antiretroviral therapy, they face an array of age-related conditions, which often affect them at higher rates than they affect the general population. Clinically defined frailty phenotype is among the threats faced by aging people with HIV. MACS investigators planned this comparison of HIV-positive and negative men in this prospective gay US cohort to assess prevalence and predictors of frailty.
Researchers define frailty as screening positive for three of five deficits: physical shrinking, weak hand-grip strength, slow walking speed, self-reported exhaustion, and self-reported low physical activity. In the elderly general population, frailty predicts loss of independence, falls, hospital admissions, and death. Previous MACS research found that persistent frailty-like phenotype before starting antiretroviral therapy independently predicted AIDS or death [2] and that lower CD4 count correlated with higher prevalence of frailty, independently of antiretroviral use [3].
This analysis involved 1946 HIV-positive and negative MACS men with at least one study visit between October 2007 and September 2011. The investigators excluded HIV-positive men not taking antiretrovirals. While 477 men (25%) had frailty at one or more study visits, 1469 did not have frailty at any visit. Median age was older in men with frailty at one or more visits (53.8 versus 50.5, P < 0.001), and a higher proportion of men with frailty were black (31% versus 21%, P < 0.001). A lower proportion of men with than without frailty had a college degree (40% versus 56%, P < 0.001).
Among the 477 men with frailty at one or more study visits, 257 (54%) had HIV and 220 did not. Among 1469 men without frailty at any study visit, 641 (44%) had HIV and 828 did not. HIV-positive and negative men both completed a median of 6 study visits; men with and without frailty also completed a median of 6 visits.
The proportion of frailty-positive visits rose with age regardless of HIV status but was almost always higher in the HIV-positive group and significantly higher starting at age 50. Among 50- to 54-year-olds, proportions of frailty-positive visits in HIV-positive and negative men were about 15% versus 6% (P < 0.001). In 55- to 59-year-olds, respective proportions of frailty-positive visits were about 15% versus 8% (P = 0.013). And among 60- to 64-year-old men, proportions of frailty-positive visits in HIV-positive and negative men were about 18% versus 9% (P = 0.018).
In the 10,267 study visits, 5% of frailty-negative visits became frailty-positive at the next visit. Nearly the same proportion of visits, 4%, reverted from frailty-positive to frailty-negative. Older age predicted conversion from a frailty-negative visit to a frailty-positive subsequent visit. Compared with men 50 to 54 years old, those 60 to 64 had 73% higher odds of converting from frailty-negative to frailty-positive (adjusted odds ratio [aOR] 1.73, 95% confidence interval [CI] 1.18 to 2.54). Compared with the 50-to-54 group, men 65 and older had more than tripled odds of converting from negative to positive (aOR 3.47, 95% CI 2.28 to 5.28).
Compared with HIV-negative men, HIV-positive men who never had AIDS had 26% higher odds of converting from frailty-negative to frailty-positive, though this association fell short of statistical significance (aOR 1.26, 95% CI 0.98 to 1.64). But compared with the HIV-negative group, HIV-positive men with AIDS had more than doubled odds of converting from negative to positive (aOR 2.26, 95% CI 1.50 to 3.39). A history of AIDS raised conversion chances almost 60% (aOR 1.57, 95% CI 1.06 to 2.34).
Four comorbidities independently raised chances of conversion from frailty-negative to frailty-positive status:
-- Hepatitis C infection: aOR 1.66, 95% CI 1.11 to 2.49
-- Depressive symptoms: aOR 2.94, 95% CI 2.35 to 3.68
-- Diabetes history: aOR 1.74, 95% CI 1.28 to 2.38
-- Kidney disease: aOR 1.53, 95% CI 1.14 to 2.05
Among HIV-positive men with frailty, 66% had two or more comorbidities; among HIV-negative men with frailty, 62% had two or more comorbidities.
Although several HIV-related factors predict a high risk of declining health in people with HIV, the MACS team proposed, "frailty phenotype may be helpful in signaling age-related nondeath outcomes."
References
1. Althoff K, Jacobson LP, Cranson RD, et al. Comorbidities and AIDS predict the frailty phenotype in men with treated HIV-1 infection. 3rd International Workshop on HIV and Aging. November 5-6, 2012, Baltimore. Abstract O_12.
2. Desquilbet L, Jacobson LP, Fried LP, et al. A frailty-related phenotype before HAART initiation as an independent risk factor for AIDS or death after HAART among HIV-infected men. J Gerontol A Biol Sci Med Sci. 2011;66:1030-1038. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156632/.
3. Desquilbet L, Margolick JB, Fried LP, et al. Relationship between a frailty-related phenotype and progressive deterioration of the immune system in HIV-infected men. J Acquir Immune Defic Syndr. 2009;50:299-306. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699396/.
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