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Critical Physical Function Loss in
Three Quarters of Over-50 HIV Group
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International Workshop on HIV and Aging, October 13-14, 2022
By Mark Mascolini for NATAP and Virology Education
Three quarters of a 50-and-older Baltimore HIV group had lost some physical function measured by the Short Physical Performance Battery (SPPB) [1]. Lower physical function predicted two impaired instrumental activities of daily living (iADL): walking and urinary continence. Age in this largely black group of HIV-positive smokers averaged only 60 years.
University of Maryland researchers who conducted this study reminded colleagues that older people with HIV run a higher risk of several comorbidities and also a general loss in physical function, which can be measured by the Short Physical Performance Battery (SPPB) [2]. SPPB has three components: balance, gait speed, and chair stand.
This analysis of the Strengthening Therapeutic Resources in Older adults aging with HIV (STRONG) program aimed to assess prevalence of poor physical function by SPPB and how it affects daily functioning, specifically health-related quality of life (HRQoL) and iADL. The researchers used logistic regression to estimate relationships between physical function and HRQoL or iADL.
STRONG enrolls people at a University of Maryland HIV outpatient clinic in Baltimore. This study focused 165 STRONG participants, 56% men, 62% single, 85% smokers, 94% black, and 94% with a viral load below 200 copies. Their age averaged 60 years and HIV duration 24 years.
Among the 165 STRONG participants tested, 76% had impaired physical function (an SPPB score at or below 10). People with impaired versus normal physical function included a lower proportion in the 50-to-58-year-old group (44% vs 54%) and in the 58-to-66 group (44% vs 46%), but a higher proportion in the 66-to-74 group (14% vs 0) (P = 0.05). Proportions of men versus women were 48% in the impaired group versus 79% in the normal group (P = 0.0006). Normal body mass index proved less frequent in the impaired group than the normal group (28% vs 49%), while obesity was more frequent with physical impairment (49% vs 18%, P = 0.002). Depression measured by Patient Health Questionnaire (PHQ)-9 was less likely to be mild with versus without impaired physical function (75% vs 90%) and more likely to be moderate (14% vs 8%) or severe (11% vs 3%) (P = 0.009).
Multivariable logistic regression linked impaired functioning to nearly tripled odds of lower mental HRQoL (adjusted odds ratio [aOR] 2.7, 95% confidence interval [CI] 1.1 to 6.8) and lower physical HRQoL (aOR 2.8, 95% CI 1.2 to 6.6). In a similar analysis of iADLs, impaired physical function quadrupled odds of walking dependency (aOR 4.4, 95% CI 1.5 to 12.9) and urinary incontinence (aOR 4.0, 95% CI 1.1 to 14.5).
The University of Maryland investigators concluded that a substantial majority of their mostly male and black over-50 HIV cohort in Baltimore had reduced physical function, which multivariate logistic regression linked to worse HRQoL and limitations on iADLs. They proposed that SBBP may be a useful clinical tool to screen for physical function in older people with HIV.
References
1. Mohanty K, Eke U, Hoffmann J, et al. Physical functioning in older people living with HIV: STRONG Study. International Workshop on HIV and Aging, October 13-14, 2022d. Abstract 19.
2. geriatrictoolkit. Short Physical Performance Battery Protocol and Score Sheet. https://geriatrictoolkit.missouri.edu/SPPB-Score-Tool.pdf
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