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More Than Half of Kampala ART Responders Are Prefrail or Frail
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International Workshop on HIV and Aging, October 13-14, 2022
By Mark Mascolini for NATAP and Virology Education
More than half of 500 HIV-positive Kampala residents 60 and older had standard signs of prefrailty or frailty, despite good responses to antiretroviral therapy (ART) [1]. Three quarters of study participants had some cognitive impairment, and 10% had depression. Having low income, cognitive impairment, or depression independently predicted frailty in this study at Kampala's Infectious Diseases Institute.
As in other parts of the world, rising access to ART in Uganda has prolonged the lives of people with HIV. But a longer lifespan puts people at risk for age-related diseases, which often occur at an earlier age in HIV-positive groups. Researchers in Kampala collaborated with investigators from the United States and Italy to determine frailty prevalence and risk factors in older people with HIV.
This cross-sectional analysis focused on people 60 or older and newly enrolled in a geriatric cohort taking long-term ART between December 2020 and December 2021. Researchers defined frailty by the five Fried phenotype criteria [2]: unintentional weight loss more than 10 pounds in the past year; self-reported exhaustion; weakness measured by grip strength; slow walking; and low physical activity. To identify frailty risk factors, the investigators used logistic regression controlled for gender, age, body mass index, pre-ART and current CD4 count, WHO HIV disease stage, years of ART, comorbidities, household income, depression, and cognitive status.
About half of participants (51%) were men, median age stood at 64 (interquartile range [IQR] 62 to 68), and median years taking ART measured 15 (IQR 10 to 17). One third of cohort members (31%) had an income lower than $1 daily (the international poverty threshold). Median CD4 count measured 159 when ART began and 645 currently. Only 2 people had a viral load above 1000 copies. One quarter of the cohort had more than one noncommunicable disease, 73% had some degree of cognitive impairment, and 10% had depression.
While 9% of cohort members were frail (3 or more Fried criteria), 46% were prefrail (1 or 2 Fried criteria) and 45% nonfrail. Multivariate analysis isolated five independent predictors of frailty in this cohort at the following adjusted odds ratios (aOR) and 95% confidence intervals (CI).
Lower frailty risk:
Normal body mass index vs underweight: aOR 0.07, 95% CI 0.01 to 0.55, P = 0.009
Overweight body mass index vs underweight: aOR 0.09, 95% CI 0.01 to 0.74, P = 0.021
Higher frailty risk:
Income less than $15 daily vs more: aOR 3.17, 95% CI 1.19 to 8.47, P = 0.022
Cognitive impairment: aOR 6.5, 95% CI 1.03 to 40.79, P = 0.046
No depression: aOR 14.66, 95% CI 3.90 to 55.13, P = 0.000
The international team who conducted this study suggested that screening HIV-positive people for frailty "may pave the way for preventive/multidisciplinary interventions in nutrition, mental health, and lifestyle."
References
1. Mbabazi P, Naikoba S, Banturaki G, et al. Risk factors for frailty in a geriatric cohort on long term antiretroviral treatment in Uganda. International Workshop on HIV and Aging, October 13-14, 2022. Abstract 13.
2. 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:M146-156. doi: 10.1093/gerona/56.3.m146. https://academic.oup.com/biomedgerontology/article/56/3/M146/545770?login=false
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