Background Patients with HIV infection suffer from accelerated aging. In this context, frailty could be a relevant problem that aggravates the quality of life (QoL) and morbi-mortality of these patients. Our objective was to determine the prevalence of frailty and pre-frailty in HIV-infected patients in our cohort as well as their risk factors and QoL. Methods This was a prospective cross-sectional study of HIV-infected people aged ≥18 years on a stable antiretroviral regimen (ART) ≥1 year. Frailty was defined by ≥3 of 5 Fried's criteria: weight loss, low physical activity, exhaustion, weak grip strength and slow walking time. Variables related to sociodemographics, HIV infection, comorbidities, polypharmacy, and QoL were evaluated. Independent predictors of frailty were evaluated using collinearity in a multivariate logistic regression analyses (backward stepwise elimination). Results The 248 people studied has a mean age of 49 years, 63.7% were male, and 81% were Caucasian. The prevalence of pre-frailty and fragility was 39.1% and 4.4%, respectively. The main route of HIV acquisition was heterosexual (47.2%). At the inclusion time 26.6% of the patients had AIDS events, 60.9% were anti-HCV negative, and 91.5% had HIV RNA <50 copies/mL (84.3% for ≥1 year); 10.9% had >2 comorbidities, and 13.3% were receiving >5 non-HIV drugs. Frailty patients had a higher age (p 0.006), more sensitive deficits (visual or auditory) (p 0.002), a greater number of falls during the previous year (p 0.0001), a higher Charlson comorbidity index (p 0.001), and a higher VACS index (p 0.001). All comorbidities, excluding bone and liver, were significantly more frequent in fragile patients. The presence of >2 comorbidities and treatment with >5 drugs not related to HIV they were also more frequent in frail patienst (p 0.0001 and p 0.004, respectively). Independent predictors of pre-frailty/frailty in the multivariable analysis differ in men (VACS index, C-reactive protein [CRP], and falls) and women (CRP, AIDS, and menopause). Patients with pre-frailty/frailty had some indicator of a lower QoL. Conclusion Factors associated with pre-frailty/frailty in HIV-infected patients differ by gender, which should be considered when establishing measures for prevention. The role of menopause in the risk of pre-frailty/frailty warrants further investigations.

Background Analysis of arterial stiffness is a good marker of early arterial disease, which also has a prognostic value. It can be determined in a simple, non-invasive and reproducible way through the pulse wave velocity (PWV), a measure that has been proved to be useful in the stratification of cardiovascular risk (CVR). Objectives To determine arterial stiffness by studying PWV in patients with rheumatoid arthritis (RA), and estimate its utility in CVR stratification in these patients. Methods 134 patients with RA were assessed over a period of one year, excluding those with high CVR (previous cardiovascular events, renal failure and/or diabetes mellitus). Gender, age, duration of RA, extra-articular disease, smoking habit, blood pressure (BP), RF and/or anti-CCP antibodies +, and atherogenic index were collected. These data were used to calculate the SCORE and mSCORE. An ultrasound (US) examination was performed with an Esaote MyLab 70 US system equipped with a linear probe (7- 12MHz) and an automated measurement of intima-media thickness (IMT) by radiofrequency (QIMT). IMT was measured in bilateral common carotid, and the presence of atherosclerotic plaques was recorded in the extracranial carotid arteries according to Mannheim Consensus. PWV measurement was performed using a Mobil O Graph device. Patients were classified as high CVR if the PWV≥10m/s (Mancia G, et al. J Hypertens 2013;31:1281-1357). Statistical analysis was performed using the SPSS 17.0 program. Results 75.4% of patients were female, the mean age was 60.36 years and 29.1% were smokers. The mean duration of RA was 17.18 years, 20.9% with extra-articular features. The percentage of patients classified as low CVR (mSCORE =0), medium (1≤mSCORE<5) high and very high (mSCORE≥5) was 23.9%, 65.8% and 10.3%, respectively. Plaques were found in 43.6% of the patients, the mean IMT being 0.74 mm. 16.2% of the patients had an IMT >0.9 mm. Patients with IMT>0.9mm and/or presence of plaque accounted for 46.2%. The average PWV was 8.84 m/s and 26.8% of the patients showed a PWV≥10m/s. 52 patients (46%) with mSCORE<5 had atheromatous plaques and/or IMT>0.9mm, and 25 (23.8%) had a PWV≥10m/s. PWV showed a correlation with mSCORE (r0.721, p 0.000) and pathological findings in carotid US (r 0.568, p 0.000). A composite gold standard for high CVR (mSCORE≥5 or mSCORE<5 with IMT>0.9 mm and/or plaque or PWV≥10m/s) was considered (Corrales A, et al. Ann Rheum Dis 2013, 72:1764-70) for the estimation of the sensitivity of the following models: Model Sensitivity Gold Standard n 63/113 mSCORE ≥5 19% (12/63) PWV ≥10m/s 52,4% (33/63) US abnormalities (IMT >0.9mm or atherosclerotic plaque) 77,8% (49/63) mSCORE ≥5 or mSCORE <5 and PWV≥10m/s 58,7% (52/63) mSCORE ≥5 or mSCORE <5 and US abnormalities 82,5% (37/63) Conclusions The sensitivity of the PWV is higher than that of the mSCORE, but lower than carotid US in estimating the CVR in patients with RA. However, it is a more fast, simple, objective and reproducible test and, therefore, can be a u...

Background Recently, a Spanish group[i] has proposed an algorithm that improves mSCORE estimation of cardiovascular risk (CVR) in patients with rheumatoid arthritis (RA), by adding the findings on carotid ultrasound (US). Objectives To estimate CV risk in our RA patients by combining mSCORE and the findings on carotid US (intima-media thickness [IMT] and/or atherosclerotic plaques). Methods A set of 188 patients with RA were assessed over a period of one year. Gender, age, duration of RA, extra-articular disease, smoking habit, blood pressure (BP), RF and/or anti-CCP antibodies +, and atherogenic index (AI) were collected. These data were used to calculate the SCORE and mSCORE. An ultrasound (US) examination was performed with an Esaote MyLab 70 US system equipped with a linear probe (7-12MHz) and an automated measurement of IMT by radiofrequency (QIMT). IMT was measured in bilateral common carotid, and the presence of atherosclerotic plaques was recorded in the extracranial carotid arteries according to Mannheim Consensus. Descriptive statistics were performed with the package SPSS 17.0. Results 188 patients were evaluated, of whom 39 were excluded for high CVR (previous cardiovascular events, renal failure and/or diabetes mellitus). 75.8% were women, the mean age was 60.05 years, and 30.9% were smokers. The mean duration of RA was 17.37 years. Anti-CCP antibodies or FR positivity were found in 66.7% and 73%, respectively. The mean BP was 130.5/80.57mmHg, and the mean AI was 3.84. The average SCORE was 1.84 and mSCORE was 2.40. The percentage of patients classified as low CVR (mSCORE=0), moderate (1≤mSCORE<5), high and very high (mSCORE≥5) was 25.6% (n=32), 64% (n=80), and 10.4% (n=13), respectively. The mean IMT was 0.73mm, and 15.2% of the patients had an IMT>0.9mm. Plaques were found in 43.2% of patients. Patients with IMT>0.9mm and/or presence of plaque accounted for 45.5%. Following the recommendations1, 40 patients classified as moderate risk (52.6%) were reclassified as high risk by the presence of one or both carotid abnormalities. Only one patient with low risk had a pathological US examination. Our patients, compared with a population of northern Spain1, had less plaques and/or IMT>0.9mm, despite being an older population with a higher percentage of males and smokers, having a longer history of illness, a higher presence of extra-articular involvement, a worse AI, and a higher average mSCORE. Conclusions Our results confirm that the CVR in RA patients is underestimated by the mSCORE and therefore, a carotid US examination is needed for the re-stratification of this risk. Compared with a population of northern Spain1, our patients have a lower vascular damage even though its clinical profile is theoretically less favorable from a CVR point of view. We could appeal to genetic or environmental factors such as diet to explain these differences. References Corrales A, et al. Ann Rheum Dis 2013 Mar 16[Epub ahead of print] Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eu...