Development of Frail RISC-HIV: a Risk Score for Predicting Frailty Risk in the Short-term for Care of People with HIV

Abstract

Objective: Frailty is common among people with HIV (PWH), so we developed frail risk in the short-term for care (RISC)-HIV, a frailty prediction risk score for HIV clinical decision-making. Design: We followed PWH for up to 2 years to identify short-term predictors of becoming frail. Methods: We predicted frailty risk among PWH at seven HIV clinics across the United States. A modified self-reported Fried Phenotype captured frailty, including fatigue, weight loss, inactivity, and poor mobility. PWH without frailty were separated into training and validation sets and followed until becoming frail or 2 years. Bayesian Model Averaging (BMA) and five-fold-cross-validation Lasso regression selected predictors of frailty. Predictors were selected by BMA if they had a greater than 45% probability of being in the best model and by Lasso if they minimized mean squared error. We included age, sex, and variables selected by both BMA and Lasso in Frail RISC-HIV by associating incident frailty with each selected variable in Cox models. Frail RISC-HIV performance was assessed in the validation set by Harrell's C and lift plots. Results: Among 3170 PWH (training set), 7% developed frailty, whereas among 1510 PWH (validation set), 12% developed frailty. BMA and Lasso selected baseline frailty score, prescribed antidepressants, prescribed antiretroviral therapy, depressive symptomology, and current marijuana and illicit opioid use. Discrimination was acceptable in the validation set, with Harrell's C of 0.76 (95% confidence interval: 0.73–0.79) and sensitivity of 80% and specificity of 61% at a 5% frailty risk cutoff. Conclusions: Frail RISC-HIV is a simple, easily implemented tool to assist in classifying PWH at risk for frailty in clinics.

The association between anticholinergic/sedative burden and physical frailty in people aging with HIV

“…Another limitation is the use of self-reported variables for gait speed and grip strength instead of performance measures, as part of the FFP. Although modifications to the FFP have been used in cohorts of people living with HIV and the general population and have been found to be highly correlated with the FFP [3,26,63,64], this approach may introduce some misclassification bias. However, any potential bias would likely be nondifferential and bias the estimated effects towards the null, making the observed estimates conservative.…”

Frailty and HIV-associated neurocognitive disorder are only modestly associated

“…Frailty, although a clinically recognizable condition, does not have an agreed upon set of defining criteria, may arise from (and be associated with) a multitude of biopsychosocial mechanisms and pathways, and measurement instruments vary greatly [5]. This study reinforces the need to develop and test valid and reliable instruments to measure frailty with attractive properties for implementation in research and clinical settings [6,7]. This is particularly salient with an aging population of PWH, and known associations between frailty and significant morbidity and mortality [8].…”