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Lower CD4 Nadir Linked to Geriatric Syndromes in 50-or-Older People
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CROI 2014, March 3-6, 2014, Boston
"authors concluded that HIV-infected adults may be at increased risk for geriatric syndromes.....'association of more geriatric syndromes with lower CD4 nadir suggests that earlier initiation of combination antiretroviral therapy may help to prevent age-related complications.' They recommended closer attention to preventing and managing comorbidities to protect older HIV-positive adults from geriatric complications.....geriatric principles should be considered in the care of aging HIV-infected population."
Mark Mascolini
Every 50-cell lower nadir CD4 count independently raised chances that people over 50 years old with well-controlled HIV infection would have at least two geriatric syndromes in a 155-person study [1]. Comorbidities and nonwhite race also raised the risk of geriatric syndromes. And these people with HIV had higher rates of four geriatric syndromes than an age-matched general-population group.
Geriatric syndromes such as frailty and falls are receiving increasing research attention as the HIV population ages. Because factors that contribute to these syndromes are multifactorial and incompletely understood, University of California, San Francisco (UCSF) researchers conducted this cross-sectional study of older adults with well-controlled HIV infection.
The analysis included members of the San Francisco SCOPE cohort who were 50 or older and taking antiretroviral therapy with an undetectable viral load for at least 3 years. The UCSF team determined how many participants had four geriatric syndromes: (1) falls, defined by self-report of falling in the past year, (2) urinary incontinence, defined by self-report based on the International Consultation on Incontinence Questionnaire, (3) prefrailty and frailty, defined by Fried frailty criteria, and (4) functional impairment, defined by self-report of Activities of Daily Living and Instrumental Activities of Daily Living. (Activities of daily living include dressing and bathing; instrumental activities of daily living include shopping and housework). The researchers compared findings with those of men in the Health and Retirement Study, a national cohort of people 50 or older. They used Poisson models to identify geriatric syndrome risk factors.
The 155 study participants had a median age of 57 (interquartile range [IQR] 54 to 62), 145 were men, and 124 were men who have sex with men. Most participants, 63%, were white, while 18% were African American and 19% another race or ethnicity. This group had HIV infection for a median of 21 years (IQR 16 to 24), and 115 (74%) had taken zidovudine or one of the d-nucleosides: didanosine (ddI), stavudine (d4T), or zalcitabine (ddC). These people had a median current CD4 count of 567 (IQR 398 to 752) and a median nadir count of 174 (IQR 51 to 327). The group had a median of 4 comorbidities (IQR 3 to 6) and took a median of 9 nonantiretroviral medications (IQR 6 to 12.).
Among study participants evaluated for the individual geriatric syndromes, 13 (9%) met frailty criteria, 79 (56%) met prefrailty criteria, 37 (26%) had fallen in the past year, 35 (24%) had urinary incontinence, 36 (25%) had difficulty with at least one activity of daily living, and 41 (28%) had difficulty with at least one instrumental activity of daily living. A large majority of study participants, 86%, had at least one geriatric syndrome, while 54% had 2 or more syndromes.
Age-adjusted comparison with 8291 members of the control cohort determined that the HIV group had significantly higher rates of urinary incontinence (24% versus 9%, P < 0.001), difficulty with activities of daily living (25% versus 12%, P < 0.001), difficulty with instrumental activities of daily living (28% versus 14%, P < 0.001), and frailty (9% versus 3%, P = 0.009). Similar proportions in the HIV and control groups fell in the past year (26% and 24%).
Three factors were independently associated with a higher risk of having two or more geriatric syndromes: Every 50-cell lower nadir CD4 count raised the risk 16% (incidence rate ratio [IRR] 1.16, 95% confidence interval 1.06 to 1.26). Nonwhites had a 38% higher risk (IRR 1.38, 95% CI 1.10 to 1.74), and comorbidity raised the risk 9% (IRR 1.09, 95% CI 1.03 to 1.15). Exposure to zidovudine or one of the d-nucleosides lowered the risk of having two or more geriatric syndromes 32% (IRR 0.68, 95% CI 0.52 to 0.90).
The researchers concluded that both HIV-related factors (nadir CD4 count) and non-HIV factors (ethnicity and number of comorbidities) were associated with increased risk of geriatric syndromes in this population. The link between zidovudine or d-drug exposure and geriatric syndromes, they proposed, could reflect a survival bias favoring people who got through the early years of antiretroviral therapy.
The investigators proposed that "association of more geriatric syndromes with lower CD4 nadir suggests that earlier initiation of combination antiretroviral therapy may help to prevent age-related complications." They recommended closer attention to preventing and managing comorbidities to protect older HIV-positive adults from geriatric complications.
from Jules: exercise & diet are the best known antidote to reduce inflammation and thereby to reduce onset for these conditions:
CROI: Geriatric Syndromes are Common Among Older HIV-Infected Adults: in this group over age 50, 50% of participants had frailty or pre-frailty ay higher frequencies than HIV-negatives - (03/10/14)
CROI: Brisk Walking Improves Inflammatory Markers in cART-Treated Patients - (03/14/14)
CROI: Physical Function Impairment on Quality of Life among Persons Aging with HIV Infection - (03/14/14)
Reference
1. Greene M, Valcour V, Miao Y, et al. Geriatric syndromes are common among older HIV-infected adults. CROI 2014. Conference on Retroviruses and Opportunistic Infections. March 3-6, 2014. Boston. Abstract 766.
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