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Poor Physical Function in Older Women on ART Tied to Comorbidities, Inflammation
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4th International Workshop on HIV and Aging, October 30-31, 2013, Baltimore
Mark Mascolini
One fifth of 40- to 66-year-old women on stable antiretroviral therapy (ART) performed poorly on a standard physical-function test, according to results of a cross-sectional study in Boston [1]. More non-HIV comorbidities, smoking, and higher interleukin 6 (IL-6, an inflammation marker) were associated with poor physical function.
Previous research found evidence that people with HIV run a higher risk of poor physical function than people without HIV, especially when CD4 counts are low [2,3]. That work linked poor physical function to non-AIDS illnesses, including hypertension, diabetes, and chronic pulmonary disease. HIV-positive people--even those responding well to ART--have persistently elevated inflammation, an association also noted in elderly individuals [4] and those with other chronic medical conditions [5].
To get a better understanding of the ties between physical function, non-AIDS illness, and inflammation, researchers in Philadelphia and Boston conducted a cross-sectional study of women 40 and older cared for at the Boston Medical Center. Study participants had a viral load of 1000 copies or lower and had taken a stable antiretroviral regimen for at least 6 months.
Among the 72 women enrolled between February and August 2011, 65 (90%) completed the physical function assessment--the Short Physical Performance Battery (SPPB), which measures balance, walking speed, and lower extremity strength (by the chair-stand method). The National Institute of Aging developed the SPPB as a simple means to assess physical function in people 65 and older [6].
The 65 women who completed the SPPB had a median age of 49 (range 40 to 66), 44 (68%) were black, 11 (17%) Hispanic, and 6 (9%) white. Median years since HIV diagnosis stood at 13 (interquartile range [IQR] 8 to 16). Fifty-eight women (89%) had a viral load below 75 copies. Median current and nadir CD4 counts were 675 and 202.
Twenty-two women (34%) smoked at the time of the evaluation, 6 (9%) currently used illicit drugs, and 25 (39%) were former illicit drug users. Median body mass index stood at 28 (IQR 24.2 to 33.7), and 40% of women were obese. Twenty-six women (40%) had one comorbid condition and 23 (35%) had two or more, including hypertension in 49%, HCV infection in 28%, hyperlipidemia in 28%, diabetes in 25%, and coronary artery disease in 5%.
Defining poor physical function as an SPPB score of 9 or lower, the researchers identified poor physical function in 13 of 65 women (20%). Women with poor physical function were marginally older (median 55 versus 48, P = 0.06), and a marginally lower proportion had a viral load below 75 copies (77% versus 92%, P = 0.14). Women with and without poor physical function did not differ much by race/ethnicity or current or nadir CD4 count.
Similar proportions of women with and without poor physical function had one or two comorbid conditions (54% versus 63%), but a higher proportion of women with poor physical function had three or more comorbid conditions (38% versus 8%, P = 0.01). A significantly higher proportion of women with poor physical function smoked (62% versus 27%, P = 0.03), and marginally higher proportions had diabetes (46% versus 19%, P = 0.07), hypertension (69% versus 44%, P = 0.13), or HCV infection (46% versus 23%, P = 0.16). The groups did not differ substantially in current illicit drug use, body mass index, or hyperlipidemia.
Among the six inflammatory markers measured, median IL-6 levels were significantly higher in the poorly functioning group (1 versus 0 ng/mL, P = 0.048), and soluble tumor necrosis factor receptor 1 was marginally higher in that group (2.0 versus 1.6 ng/mL, P = 0.09). Inflammatory variables that did not differ substantially between groups were soluble CD14, transforming growth factor beta-1, hyaluronic acid, and lipopolysaccharide endotoxin unit.
Because of the relatively small number of women studied, the researchers could not perform multivariate analyses. They cautioned that the relatively easy SPPB test may miss more subtle defects and that the results may not apply to women with poorly controlled HIV infection. Strengths of the study include the diversity of the population and use of trained exercise physiologists to assess physical function.
References
1. Baranoski AS, Harris A, Michaels D, et al. Relationship between poor physical function, inflammatory markers and co-morbidities in HIV-infected women on antiretroviral therapy. 4th International Workshop on HIV and Aging, October 30-31, 2013, Baltimore. Abstract 2.
2. Terzian AS, Holman S, Nathwani N, et al. 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. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828186/
3. Oursler KK, Goulet JL, Crystal S, et al. Association of age and comorbidity with physical function in HIV-infected and uninfected patients: results from the Veterans Aging Cohort Study. AIDS Patient Care STDS. 2011;25:13-20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030913/
4. Tiainen K, Hurme M, Hervonen A, Luukkaala T, Jylha M. Inflammatory markers and physical performance among nonagenarians. J Gerontol A Biol Sci Med Sci. 2010;65:658-663. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657165/
5. Brinkley TE, Leng X, Miller ME, et al. Chronic inflammation is associated with low physical function in older adults across multiple comorbidities. J Gerontol A Biol Sci Med Sci. 2009;64:455-461. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657165/
6. National Institute of Aging. Assessing physical performance in the older patient. http://www.grc.nia.nih.gov/branches/leps/sppb/
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