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Age, Comorbidities, and AIDS Predict a Frailty
Phenotype (FP) in Men Who Have Sex With Men
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• Risk Factors for Frailty in PLWH Reported.
• 25% >65 with HIV Frail in MACS.
• After age 50 raes of frailty among MSM in MACS 2-3 times higher vs HIV-neg MSM.
The Journals of Gerontology February 2014
To our knowledge, this study is the first to evaluate the prevalence and expression of the FP defined and validated by Fried and colleagues (6,7), in HIV+ and similar HIV- MSM. Prevalence of the FP was higher in HIV+ compared with HIV- men, particularly in those aged 50 and older. We found substantial fluctuation in FP+ status in our study population. Examining factors associated with FP conversion allowed for consideration of this fluctuation. Concordance of FP+ status and comorbidities was high, but a sizable proportion of HIV+ and HIV- men were FP+ with fewer than two comorbidities, suggesting that FP+ and comorbidities are not synonymous.
Conversion from FP- to FP+ status was significantly associated with the presence of conditions known to be associated with expression of the FP in elderly HIV- people (eg, depressive symptoms, diabetes, kidney disease, hepatitis C infection, and cigarette smoking). The fact that many factors and organ systems were associated with conversion suggests that expression of the FP is indicative of multisystem dysfunction in our study population, as it is in the older HIV- population. HIV infection, independent of these comorbidities, was significant only in the presence of a history of AIDS, suggesting that men who had AIDS before the introduction of HAART may have driven the association of HIV infection with expression of the FP.
Of the 1,946 men studied, 1,469 (75%) were FP- at all visits contributed, and 477 (25%) were FP+ at one or more visits (Table 1). The latter were older and more likely to be HIV+ or non-Hispanic black, and of lower educational attainment (Table 1).
As expected, the proportion of FP+ visits increased with increasing age (Figure 1). This proportion was greater in HIV+ men for all age groups except for 45-49 years, and these differences were statistically significant for men aged 50-65 years. The intraclass correlation coefficients were 0.491 for HIV+ men and 0.579 for HIV- men, suggesting that a substantial proportion of the variability in expression of the FP was within men, similar to the level between men.
Among the 477 men who were ever FP+, 216 (45%) were FP+ at only one visit. Because the vast majority of these men completed six or more visits, as mentioned earlier, it can be inferred that FP+ expression was often transient.
This analysis was based on 9,309 (8,772 FP-, FP- and 537 FP-, FP+) consecutive visit pairs from 778 HIV+ and 935 HIV- men. Univariate and multivariate results are shown in Table 2. Overall, HIV infection was associated with a 46% increase in the odds of conversion in univariate models (odds ratio = 1.46 [1.18, 1.81]); HIV infection with and without AIDS was significantly associated with conversion (odds ratios relative to HIV- men = 2.56 [1.75, 3.75] and 1.31 [1.05, 1.64], respectively).
To better understand the relationship between comorbidities and HIV and AIDS status, we examined the prevalence of hepatitis C and age-related comorbidities measured at the first visit during the study period (N = 1,496). HIV+ men were more likely to have hepatitis C infection, depression, diabetes, and kidney disease and less likely to have high blood pressure, than HIV- men (Table 3). Dyslipidemia was the most common comorbidity in both HIV+ and HIV- men. HIV+ men also had a higher proportion with two or more comorbidities.
Risk Factors for Frailty in HIV
In multivariate models, the association of HIV and AIDS status with conversion remained elevated but only HIV infection with AIDS was significant. Additionally, the odds of FP conversion increased with
- older age (see >65: 25% frail),
- non-Hispanic black race/ethnicity,
- cigarette smoking,
- hepatitis C infection,
- depressive symptoms,
- history of diabetes,
- and kidney disease,
- whereas the opposite was true for education to college or beyond (Table 2).
Abstract
Background.
Adults aging with HIV infection are at risk for age-related comorbidities and syndromes, such as frailty. The objective of this study was to evaluate the expression and predictors of the frailty phenotype (FP) among HIV-infected (HIV+) and HIV-uninfected (HIV-) men who have sex with men.
Methods.
A prospective, observational cohort study was nested in the Multicenter AIDS Cohort Study from October 2007-September 2011. FP conversion was defined as the onset of FP over two consecutive study visits. Adjusted odds ratios and 95% confidence intervals ([,]) for FP conversion were estimated using logistic regression models with generalized estimating equations.
Results.
Of 10,571 completed study visits from 1,946 men who have sex with men, 12% and 9% were FP+ among HIV+ and HIV- men, respectively (p = .002). The proportion of FP+ visits increased with age regardless of HIV status, but was significantly greater in HIV+ compared to HIV- men aged 50-64 years. Of the 10,276 consecutive visit pairs contributed by participants, 5% (537) were classified as FP conversion, and 45% of the men with FP conversion had only one FP+ study visit. FP conversion was significantly associated with a history of AIDS (adjusted odds ratios = 2.26 [1.50, 3.39], but not with HIV+ alone (adjusted odds ratios = 1.26 [0.98, 1.64]). Among men who had one or more FP+ visits, 34% of HIV+ and 38% of HIV- men had less than two comorbidities.
Conclusions.
These findings suggest that expression of the FP can be measured in men who have sex with men with and without HIV infection and reflects multisystem dysfunction in this population; further investigations are needed to better understand clinical utility.
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