HIV Infection Is Independently Associated with Frailty in Middle-Aged HIV Type 1-Infected Individuals Compared with Similar But Uninfected Controls
BACKGROUND:
Frailty
is an age-related syndrome of decreased physiological reserve and resistance to
stressors, associated with increased morbidity and mortality in the general
elderly population. An increased prevalence of frailty has been reported
amongst HIV-infected individuals.
METHODS:
Fried
frailty phenotype was systematically assessed in predominantly virologically
suppressed HIV type 1 (HIV-1)-infected and otherwise comparable HIV-uninfected
participants aged at least 45 at enrollment into the AGEhIV Cohort Study.
Multivariable ordinal logistic regression was used to investigate associations
between HIV- and antiretroviral therapy-related covariates, markers of
inflammation and body composition and prefrailty/frailty.
RESULTS:
Data were
available for 521 HIV-infected and 513 HIV-uninfected individuals. Prevalence
of frailty (10.6 versus 2.7%) and prefrailty (50.7 versus 36.3%) were
significantly higher in HIV-infected individuals (Ptrend < 0.001). HIV
infection remained statistically significantly associated with
prefrailty/frailty after adjustment for age, sex, race/ethnicity, smoking,
hepatitis C infection, comorbidities and depression [adjusted odds ratio
(ORadj) 2.16, P < 0.001]. A higher waist-to-hip ratio attenuated the
coefficient of HIV-infected status (ORadj 1.93, P < 0.001), but not waist-
or hip-circumference individually or markers of inflammation. Within the
HIV-infected group, parameters related to body composition were most strongly
and independently associated with prefrailty/frailty: current BMI less than
20 kg/m (OR 2.83, P < 0.001), nadir BMI less than 20 kg/m (OR 2.51,
P < 0.001) and waist-to-hip ratio (OR 1.79 per 0.1 higher, P < 0.001).
CONCLUSION:
HIV
infection was independently associated with prefrailty/frailty in middle-aged
HIV-infected patients compared with HIV-uninfected controls. This partly may be
mediated by the higher waist- and lower hip-circumference in the HIV-infected
individuals, potentially partially caused by lipodystrophy, and in part be a
consequence of historic weight loss associated with advanced HIV-disease.
- 1aDepartment of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development bDivision of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA) cDepartment of Neurology, Academic Medical Center dDepartment of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands eDivision of Medicine, McGill University Hospital Center, Montreal, Canada fHIV Monitoring Foundation, Amsterdam, The Netherlands.
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