Background: Frailty and physical function impairments occur at an earlier than expected age in people with HIV (PWH). The goal of this study was to determine which tools or combination of tools assessing frailty/physical function were most predictive of mortality in a middle-aged population of PWH.Methods: Using electronic health records, we determined survival, death, or loss-to-follow-up for 395 PWH, aged 45-65 originally enrolled in a 2009-2010 cross-sectional cohort study. The predictive accuracy of various physical function measures (frailty score, VACS Index, 400-m walk, SPPB, grip strength, and falls) were compared using integrated time-dependent ROC (ROC-AUC) curves in single variable models. Two-variable models were compared to the best single-variable model to determine if AUC improved with additional physical function variables.Results: At eight-year follow-up, frailty, 400-m walk pace, SPPB, chair rise pace, VACS score, and falls were associated with increased hazard of mortality; grip strength was only predictive in sex-adjusted models. The VACS index and 400-m walk pace were the best individual predictors of mortality with time-dependent ROC-AUC scores of 0.82, followed by SPPB (0.73), chair-rise pace (0.68), falls (0.65), frailty (0.63) and grip strength (0.55). Addition of the 400-m walk to VACS index yielded the only significant improvement in the prediction of survival compared to the VACS index alone (p-value=0.04). Conclusion:Our study highlights several clinically applicable physical function measures predictive of mortality in middle-aged PWH that can be tailored to specific patient sub-populations and clinical or research encounters.
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