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Rapid Rise in Frailty in First 3 Years of Menopause in HIV+ Women, Then Stable
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6th International Workshop on HIV and Aging
October 5-6, 2015, Washington, DC
Mark Mascolini
Frailty assessed by a 30-item index rose sharply in the first 3 years of menopause in a study of HIV-positive women in Italy [1]. After that frailty as measured by this index stabilized.
Researchers at the Modena HIV Metabolic Clinic and collaborators at Dalhousie University in Halifax undertook this retrospective study to track changes in frailty in HIV-positive women who were premenopausal, postmenopausal, or making the transition from premenopause to postmenopause. They used a 30-item deficit-accumulation frailty index [2] and stratified women by hormone levels into three groups: 350 premenopausal women, 148 postmenopausal women, and 182 women who had observations both before and after the menopause. The investigators used a generalized estimating equation (GEE) linear regression model to assess associations between time from menopause and frailty index.
The 680 women had 1725 frailty index assessments, 985 before menopause and 740 after menopause. All women were taking combination antiretroviral therapy and 85% had an undetectable viral load. Median CD4 count measured 537 (interquartile range 381 to 719). Age at the first frailty assessment averaged 42 in the premenopausal group, 52 in the postmenopausal group, and 46 in the transition group. Respective follow-up times averaged 3.5, 3.8, and 6.7 years. And respective initial frailty indices were 0.30 +/- 0.09, 0.40 +/- 0.09, and 0.31 +/- 0.08.
GEE regression analysis showed that the frailty index increased after women passed the menopause, independently of age (beta = 0.04, 95% confidence interval [CI] 0.03 to 0.05, P < 0.001). Across all ages postmenopausal women had higher frailty indices than premenopausal women.
Next the researchers focused on 131 women who had frailty assessed before menopause, in the transition to menopause, and in the early and late menopausal periods. This analysis included 579 frailty index evaluations and 1577 person-years of follow-up. Frailty index values rose significantly in the early menopause period (early versus premenopause beta = 0.01, 95% CI 0.001 to 0.02, P = 0.038) then tended to stabilize starting around 3 years after menopause (late menopause versus premenopause beta = 0.01, 95% CI -0.0001 to 0.02, P = 0.05).
Summarizing their findings, the Modena team noted "dynamic changes in frailty index values, with rapid increases in the first 3 years after onset of menopause and subsequent stabilization."
References
1. Zona S, Brothers T, Malagoli A, et al. Changes with menopause in the distribution of a frailty index (FI) in HIV infected women. 6th International Workshop on HIV and Aging. October 5-6, 2015, Washington, DC. Abstract 23.
2. Guaraldi G, Brothers TD, Zona S, et al. A frailty index predicts survival and incident multimorbidity independent of markers of HIV disease severity. AIDS. 2015;29:1633-1641. http://www.ncbi.nlm.nih.gov/pubmed/26372273
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