Abstract:Ever since the introduction of highly active antiretroviral therapy (ART) in 1995, HIV infection has been linked to “metabolic” complications (insulin resistance, dyslipidemia, osteoporosis, and others). Studies suggested increased rates of myocardial infarction, renal insufficiency, neurocognitive dysfunction, and fractures in HIV-postitive patients. Even long-term suppression of HIV seemed to be accompanied by an excess of deleterious inflammation that could promote these complications. The aims of this view… Show more
“…Median plasma HIV RNA was undetectable (77% of the sample). There was a significant burden of medical comorbidities, with an average of 2.7 medical conditions per person (median 3, IQR [1][2][3][4]). Almost one-half of the sample smoked, had hypertension, and hyperlipidemia, and over one-half displayed DSPN.…”
Section: Cohort Characteristicsmentioning
confidence: 99%
“…Other factors significantly associated with FFI components after multivariable analysis were for the most part conceptually congruent: for example, weight loss was associated with smoking and cancer, worse physical activity and exhaustion with increased BMI, and worse physical activity with COPD. 4 AIDS 2019, Vol 00 No 00…”
Section: Associations With Frailty Componentsmentioning
confidence: 99%
“…Frailty is a phenotype that accounts for some of this variability; within each stratum of disability, frailty predicts survival [1,2]. Adults living with HIV exhibit frailty more frequently than HIV-negative individuals of similar age, but whether this increase is a consequence of HIV itself or of its comorbidities is debated [3,4]. Some also question the validity of frailty measurement tools in populations with mean ages under 50 [3,4].…”
Section: Introductionmentioning
confidence: 99%
“…Adults living with HIV exhibit frailty more frequently than HIV-negative individuals of similar age, but whether this increase is a consequence of HIV itself or of its comorbidities is debated [3,4]. Some also question the validity of frailty measurement tools in populations with mean ages under 50 [3,4]. As combination antiretroviral therapy (cART)-era HIV populations enter decades for which common frailty measures were designed, determinants of frailty will be important to identify in order to optimize clinical management.…”
Sueiras i , for the NNTC Objectives: Multimorbidity and frailty are consequences of aging with HIV, yet not everyone with medical disease is frail. Our objective was to identify factors associated with frailty in a multimorbid HIV-infected cohort. Design: Analysis of a prospective, observational, longitudinal cohort. Methods: Three hundred and thirty-two participants in the medically advanced NNTC were categorized as frail, prefrail, or robust with the Fried Frailty Index. A series of logistic regression analyses (first univariate, then multivariable) were conducted to determine whether medical comorbidities, immunologic and virologic parameters, and/or neuropsychiatric variables predicted increased odds of frailty. Results: The mean number of medical comorbidities per participant was 2.7, mean CD4 þ T-cell count was 530 cells/ml, and 77% had undetectable HIV RNA in blood. Twenty-two percent were frail, 55% prefrail, and 23% robust. Significant predictors of frailty in multivariable analysis were cognitive diagnosis rendered by Frascati criteria, depressive symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and sex. Men were less likely to be frail than women. Higher odds of frailty were seen with: symptomatic, but not asymptomatic, cognitive impairment (compared with cognitive normals); more depressive symptoms; diabetes mellitus; and COPD. Conclusion: Neuropsychiatric illness increased odds of being frail on a predominantly physical/motoric measure, but only when symptomatic. Lack of association with asymptomatic impairment may reflect the importance of functional limitation to frailty, or possibly a unique resilience phenotype. Understanding why sex and symptomatic neuropsychiatric illness are associated with frailty will be important in managing HIVassociated morbidity in aging populations.
“…Median plasma HIV RNA was undetectable (77% of the sample). There was a significant burden of medical comorbidities, with an average of 2.7 medical conditions per person (median 3, IQR [1][2][3][4]). Almost one-half of the sample smoked, had hypertension, and hyperlipidemia, and over one-half displayed DSPN.…”
Section: Cohort Characteristicsmentioning
confidence: 99%
“…Other factors significantly associated with FFI components after multivariable analysis were for the most part conceptually congruent: for example, weight loss was associated with smoking and cancer, worse physical activity and exhaustion with increased BMI, and worse physical activity with COPD. 4 AIDS 2019, Vol 00 No 00…”
Section: Associations With Frailty Componentsmentioning
confidence: 99%
“…Frailty is a phenotype that accounts for some of this variability; within each stratum of disability, frailty predicts survival [1,2]. Adults living with HIV exhibit frailty more frequently than HIV-negative individuals of similar age, but whether this increase is a consequence of HIV itself or of its comorbidities is debated [3,4]. Some also question the validity of frailty measurement tools in populations with mean ages under 50 [3,4].…”
Section: Introductionmentioning
confidence: 99%
“…Adults living with HIV exhibit frailty more frequently than HIV-negative individuals of similar age, but whether this increase is a consequence of HIV itself or of its comorbidities is debated [3,4]. Some also question the validity of frailty measurement tools in populations with mean ages under 50 [3,4]. As combination antiretroviral therapy (cART)-era HIV populations enter decades for which common frailty measures were designed, determinants of frailty will be important to identify in order to optimize clinical management.…”
Sueiras i , for the NNTC Objectives: Multimorbidity and frailty are consequences of aging with HIV, yet not everyone with medical disease is frail. Our objective was to identify factors associated with frailty in a multimorbid HIV-infected cohort. Design: Analysis of a prospective, observational, longitudinal cohort. Methods: Three hundred and thirty-two participants in the medically advanced NNTC were categorized as frail, prefrail, or robust with the Fried Frailty Index. A series of logistic regression analyses (first univariate, then multivariable) were conducted to determine whether medical comorbidities, immunologic and virologic parameters, and/or neuropsychiatric variables predicted increased odds of frailty. Results: The mean number of medical comorbidities per participant was 2.7, mean CD4 þ T-cell count was 530 cells/ml, and 77% had undetectable HIV RNA in blood. Twenty-two percent were frail, 55% prefrail, and 23% robust. Significant predictors of frailty in multivariable analysis were cognitive diagnosis rendered by Frascati criteria, depressive symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and sex. Men were less likely to be frail than women. Higher odds of frailty were seen with: symptomatic, but not asymptomatic, cognitive impairment (compared with cognitive normals); more depressive symptoms; diabetes mellitus; and COPD. Conclusion: Neuropsychiatric illness increased odds of being frail on a predominantly physical/motoric measure, but only when symptomatic. Lack of association with asymptomatic impairment may reflect the importance of functional limitation to frailty, or possibly a unique resilience phenotype. Understanding why sex and symptomatic neuropsychiatric illness are associated with frailty will be important in managing HIVassociated morbidity in aging populations.
“…We also began to talk about “accelerated ageing” and “frailty,” but these concepts may have been a bit exaggerated in a largely middle‐aged, ambulatory population with suppressed HIV‐1 RNA who were living independently. Once differences in the underlying distribution of ages in the population with HIV versus the general population and higher rates of smoking are accounted for, people ageing with HIV do not appear to develop specific age‐associated conditions such as cancer, cardiovascular disease or renal disease at substantially earlier ages than the general population.…”
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