Frailty, Inflammation, and Mortality among Persons Aging with HIV Infection and Injection Drug Use

Serum markers of inflammation increase with age and have been strongly associated with adverse clinical outcomes among both HIV-infected and uninfected adults. Yet, limited data exist on the predictive and clinical utility of aggregate measures of inflammation. This study sought to evaluate the relationship of a recently validated aggregate inflammatory index with frailty and mortality among aging HIV-infected and uninfected injection drug users.

Frailty was assessed among HIV-infected and uninfected participants in the AIDS Linked to the IntraVenous Experience (ALIVE) cohort study using the five Fried phenotypic criteria: weight loss, exhaustion, low physical activity, decreased grip strength, and slow gait. The aggregate inflammatory index was constructed from serum measures of interleukin-6 and soluble tumor necrosis factor-α receptor-1. Multinomial logistic regression was used to assess the relationship of frailty with inflammation. Cox proportional hazards models were used to estimate risk for all-cause mortality.

Among 1,326 subjects, the median age was 48 years and 29% were HIV-infected. Adjusting for sociodemographics, comorbidity, and HIV status, frailty was significantly associated with each standard deviation increase in log interleukin-6, log tumor necrosis factor-α receptor-1 and inflammatory index score. Adjusting for sociodemographics, comorbidity, HIV status, and frailty, the inflammatory index score was independently associated with increased mortality.

A recently validated, simple, biologically informed inflammatory index is independently associated with frailty and mortality risk among aging HIV-infected and uninfected injection drug users.

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By: Piggott DA1, Varadhan R2, Mehta SH3, Brown TT4, Li H5, Walston JD5, Leng SX5, Kirk GD6.

• 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland.
• 2Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
• 3Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland.
• 4Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland.
• 5Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
• 6Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.