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FRAILTY PHENOTYPE IN OLDER VIROLOGICALLY SUPPRESSED PLWH IS STRONGLY CORRELATED WITH SPECIFIC COMORBIDITIES AND TOBACCO USE
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10 October 2019, International Workshop on HIV and Ageing, New York
Reported by Jules Levin
Christina K. Psomas, N. Petit, I. Ravaux, P. Philibert, F. Tollinchi, T. Allegre, R. Cohen-Valensi, JP. de Jaureguiberry, G. Pichancourt, L. Pelissier, S. Chadapaud, S. Bregigeon, A. Darque, F. Retornaz, P.
program abstract
Frailty phenotype in older virologically suppressed PLWHIV is strongly correlated with specific comorbidities and tobacco use M
Psomas C1, Petit N2, Ravaux I2,3, Philibert P1, Tollinchi F6, Allegre T10, Cohen-Valensi R7, de Jaureguiberry, J8, Pichancourt G12, Pelissier L11, Chadapaud S9, Bregigeon S2, Darque A2, Retornaz F1,4, Enel P2,4
1European Hospital Marseille, Department of Infectious Diseases and Internal Medicine, Marseille, France, 2Assistance Publique, Hôpitaux de Marseille, University Hospital, Marseille, France, 3Institut Hospitalo-Universitaire Mediterranee Infection, Marseille, France, 4Department of Public Health, Self-Perceived Health Assessment Research Unit EA3279, Aix-Marseille University, Marseille, France, 5Institut Hospitalo-Universitaire Mediterranee Infection, Marseille, France, 6Department of Dermatology, Saint-Joseph Foundation Hospital, Marseille, France, 7Department of Internal Medicine, Martigues Hospital Center, Martigues, France, 8Department of Internal Medicine and Oncology, Sainte-Anne Military hospital, Toulon, France, 9Department of Internal Medicine, Hyères-les-Palmiers Hospital Center, Hyères-les-Palmiers , France, 10Department of Internal Medicine and Hemato-Oncology, Aix-en-Provence Hospital Center, Aix-en-Provence, France, 11Department of Internal Medicine, Gap Hospital Center, Gap, France, 12Department of Clinical Hematology and Medical Oncology, Avignon Hospital Center, Avignon, France
People living with HIV (PLWHIV) are mostly virologically suppressed and efficiently followed up, growing older and older and accumulating health problems related to ageing. This ageing state is characterised by a decreased capacity to manage adverse outcomes (disease, hospitalization, disability, falls, trauma) which defines the frailty phenotype.
Our aim was to assess factors related to frailty according to Fried phenotype in a French cohort of elder PLWHIV.
This cross-sectional multicenter study was carried out between November 2012 and April 2014 in 12 HIV-dedicated Hospital Units of the South of France including PLWHIV of at least 50 years-old. We evaluated demographic factors, HIV-related parameters (duration of HIV diagnosis, history of AIDS diagnosis, ART duration, CD4 T cell count, CD4 T cell nadir count, viral suppression), as well as general health parameters (BMI for Body Mass Index, associated comorbidities, pain scale, social deprivation). Phenotype of Frailty according to Fried is based on the assessment of 5 criteria: shrinking (unintentional weight loss), weakness (grip strength), poor endurance (exhaustion), slowness (walking speed) and physical activity. Frailty phenotype corresponded at the presence of at least 3 criteria of the above mentioned.
Our study involved 509 PLWHIV, 72.8% were male, of a mean age of 58.4 ± 7 years, mostly (87.9%) virologically suppressed. Mean duration of infection since HIV diagnosis was 18.3 ± 7.4 years. Prevalence of frailty in our cohort concerned 8.2% between them. Univariate analysis evidenced no association (at p <0.05) of frailty with age, sex, level of studies, tobacco/alcohol or drug use, or HIV-related parameters. On the contrary, significant associations at p <0.05 were found between frailty and BMI, pain scale, social deprivation, professional activity, psychiatric history, falls, rheumatologic history, and having at least 2 comorbidities.
Multivariate analysis of variables selected at p <0.20 in the univariate model confirmed associations of frailty state with BMI (OR = 1.34[1.12-1.22], p = 0.00), pain scale (OR = 1.46 [1.07-1.25], p = 0.004), psychiatric (OR = 7.62 [1.03-2.80], p = 0.044) and rheumatologic history (OR = 7.84 [1.05-2.86], p = 0.040), falls (OR = 8.33 [1.09-3.01], p = 0.034), while revealing associations of frailty with cancer history (OR = 15.03 [1.61-4.92], p = 0.005), tobacco use (OR = 11.52 [1.37-3.97], p = 0.011) and CD4 T cell nadir count less than 200/mm3 (OR = 0.74 [0.11-0.29], p = 0.010).
Our study strongly suggests that comorbidities are the main factors that convey the embrittlement state of older virologically suppressed PLWHIV. This embrittlement state precedes polypathology or disabilities and undermines ones capacity to fight against physical or mental assaults. Efficient medical follow-up focusing on preventing comorbidities especially in individuals with cancer history, could delay frailty as well as its associated adverse outcomes.
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