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Frailty Predicts Mortality in a Cohort of HIV-Infected and At-Risk Injection Drug Users: being HIV+ & frail increased mortality risk 8-fold in this group
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Reported by Jules Levin
CROI 2012 March 5-8 Seattle, WA
DamaniA. Piggott, AbimerekiD. Muzaale, ShrutiH. Mehta, Todd T. Brown, Sean X. Leng, Gregory D. KirkJohns Hopkins University, Baltimore, MD, USA
"increasing age and HIV status were associated with increased mortality risk .....Being both HIV positive and frail conveyed an 8-fold increased risk of death relative to non-frail, HIV uninfected IDUs (HR, 8.14...)"
ABSTRACT
Background: Frailty, a syndrome of diminished physiologic reserve with increased stressor vulnerability, predicts hospitalization, disability, and mortality in older HIV-uninfected adults. We have previously observed a significant association between frailty and HIV, particularly advanced HIV infection, among injection drug users (IDUs). In this study, we evaluated the impact of frailty on mortality in a cohort of aging HIV positive and at risk IDUs.
Methods: Frailty was assessed biannually from 2005-2008 among current and former IDUs in the ALIVE cohorts and was defined by the presence of ≥3 of 5 standard criteria: weakness (grip strength), slow gait speed, weight loss, low physical activity, and exhaustion. Cox proportional hazards models with time-varying covariates were used to estimate the risk (hazard ratios [HR] with 95% confidence intervals [CI]) for all cause mortality among frail persons relative to their robust counterparts (defined by the absence of any criteria) and to nonfrailpersons.
Results: For 1230 subjects at baseline, the median age was 48 years, 89% were African American, 418 (34%) were female, and 351 (29%) were HIV+. The prevalence of frailty was 9% while 31% met no frailty criteria. In Cox multivariable analysis of 3,365 person-visits, increasing age and HIV status were associated with increased mortality risk.
Adjusting for age, race/ethnicity, gender, educational level and HIV status, frail persons had a 3.4-fold increased risk of death relative to robust persons (HR, 3.42; 95%CI 1.70-6.88). In stratified analysis, increased mortality risk with frailty was observed among both HIV-persons (HR, 2.99; 95%CI, 1.09-8.18) and HIV+ persons (HR, 3.75; 95%CI, 1.39-10.2). In comparison to non-frail persons, similar associations of frailty with mortality were observed. Being both HIV positive and frail conveyed an 8-fold increased risk of death relative to non-frail, HIV uninfected IDUs (HR, 8.14; 95%CI, 4.09, 16.2).
Conclusion: Frailty is a significant predictor of mortality among both HIV-infected and at risk IDUs. Further exploration of the biological mechanisms and clinical utility of frailty may aid management of aging HIV-infected persons.
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