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  11th International Workshop
on HIV and Aging
30 September - 2 October 2020
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Frailty Common in HIV+ Middle-Aged: Tied to Depression, HCV, Substance Use
  11th International Workshop on HIV & Aging Virtual Meeting, September 30 to October 2, 2020
By Mark Mascolini for NATAP and Virology Education
Frailty defined by 4 of the 5 standard Fried frailty phenotype criteria [1] affected 12% of a nationwide US HIV cohort, while more than 4 in 10 people met prefrailty criteria [2]. Depression, HCV coinfection, and some substance use behaviors independently raised the risk of frailty or prefrailty. Men who have sex with men (MSM) ran a lower risk of frailty or prefrailty.
Frailty is a well-established phenotype in older people in the general population. Research indicates that it affects relatively younger people with HIV infection. To assess frailty prevalence and associations with other clinical and demographic factors in the current HIV treatment era, researchers working with the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) conducted this cross-sectional study.
The analysis involved HIV-positive adults seen at 7 CNICS centers across the United States in 2011-2019. Cohort members complete clinical self-assessments every 6 months, which include questions on substance use, physical activity, and symptom burden. Researchers validate comorbidities with clinical records.
The CNICS team used 4 of the 5 standard frailty phenotype components [1] to rate each participant for frailty status: weight loss, fatigue, low physical activity, and low mobility (they left out grip strength): no frailty, 0 components; at risk or prefrailty, 1 or 2 components; frail, 3 or 4 components. The researchers used multivariable relative risk regression to identify associations between prefrailty or frailty and an array of demographic and clinical characteristics.
The analysis considered 12,714 people with HIV infection, 86% of them men and 48% white. Age averaged 47 years (standard deviation 12), with the average ranging from 46 in nonfrail people to 49 in people with frailty. While 42% of these people were at-risk of prefrail, 12% were frail. Almost half of the group, 45%, reported low physical activity, 42% reported fatigue, 36% low mobility, and 32% weight loss.
Depression boosted chances of frailty (vs not frail) more than 6-fold (relative risk [RR] 6.29, 95% confidence interval [CI] 5.63 to 7.04) while almost tripling chances of at-risk/prefrail status (RR 2.95, 95% CI 2.65 to 3.29). HCV coinfection upped the risk of frailty (vs not frail) 32% (RR 1.32, 95% CI 1.21 to 1.43), while lifting the risk of at-risk/prefrail status 21% (RR 1.21, 95% CI 1.10 to 1.34). Every additional decade of life inflated risk of frailty or at-risk/prefrailty about 10%, while MSM had more than a 10% lower risk of frailty or at-risk/prefrailty.
Several substance use behaviors made frailty and prefrailty more likely: current methamphetamine use, current smoking, and past or current illicit opioid use. Past or current cocaine or crack and past or current marijuana lifted chances of prefrailty. Compared with nondrinkers of alcohol, nonhazardous drinkers had a lower risk of frailty (RR 0.82, 95% CI 0.74 to 0.91) or at-risk/prefrailty (RR 0.92, 95% CI 0.87 to 0.96). Hazardous drinking, compared with not drinking, also cut the risk of frailty (RR 0.69, 95% CI 0.61 to 0.79) or at-risk/prefrailty (RR 0.91, 95% CI 0.86 to 0.96). (Researchers sometimes observe that nondrinkers in analyses like these can be people who drank heavily for much of their life, damaged their health, then quit.)
The CNICS investigators believe their findings establish that frailty is common in the current HIV treatment era. They called for longitudinal studies to explore the time sequence of associated variables and frailty, particularly in people who change substance use patterns.
1. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-56. doi: 10.1093/gerona/56.3.m146. 2. Ruderman S, Whitney B, Nance R, et al. Associations between frailty and clinical characteristics, comorbidities, and substance use among people living with HIV. 11th International Workshop on HIV & Aging Virtual Meeting, September 30 to October 2, 2020. Abstract 22.