Diminished physical function in older HIV-infected adults in the Southeastern U.S. despite successful antiretroviral therapy

Abstract

BackgroundAs antiretroviral therapy efficacy improves, HIV is gradually being recognized more as a chronic disease within the aging HIV-infected population. While these individuals are surviving into old age, they may, however, be experiencing “accelerated aging” with greater declines in physical function than that observed among comparably matched individuals free of HIV. This decline is not well understood and it remains unclear if physical decline correlates with the degree of immunosuppression based on CD4 lymphocyte nadir.MethodsIn a cross-sectional study of accelerated aging in the older HIV-infected population on antiretroviral therapy (ART), physical performance evaluations were completed on a cohort of 107 HIV-infected subjects, age 50 years or older (with no HIV-1 RNA >200 copies/mL in the prior 12 months), and compared to reference ranges for age- and gender-matched HIV-uninfected persons. Physical performance testing consisted of four validated assessments: the 2.4-meter walk, 30-second chair stand, grip strength and 6-minute walk test.ResultsWhen compared to age- and gender-matched HIV-uninfected reference controls, older HIV-infected persons had diminished physical function. No correlation was found between physical function and degree of immunosuppression as determined by pre-ART CD4 nadir.ConclusionsDespite improved survival, HIV–infected adults on suppressive ART have diminished physical function compared to HIV-uninfected persons. The degree of HIV-associated immunosuppression does not correlate with the observed degree of physical function decline in older HIV-infected persons, suggesting the decline is mediated by other mechanisms.

Supplementing Glycine and N-acetylcysteine (GlyNAC) in Aging HIV Patients Improves Oxidative Stress, Mitochondrial Dysfunction, Inflammation, Endothelial Dysfunction, Insulin Resistance, Genotoxicity, Strength, and Cognition: Results of an Open-Label Clinical Trial

“…Declining physical function is a key defect associated with premature aging in PWH, and manifests as lower gait speed, muscle strength, and exercise capacity [ 9 ]. The mechanistic underpinnings of declining physical function in PWH with premature aging are not well understood.…”

“…For example, a recent study in 336 young PWH (median age 44 years) found that compared to age, sex, and ethnicity-matched uninfected controls, the burden of geriatric conditions was significantly higher in PWH, together with lower quality of life scores, 5-fold higher healthcare utilization, and 4-fold higher mortality [ 6 ]. Other reports have linked early aging in PWH to diverse health conditions ranging from declining gait speed [ 8 ], physical function [ 9 ] and cognition [ 10 , 11 ], mitochondrial aging [ 12 , 13 ], and elevated inflammation [ 14 , 15 , 16 ]. Additional evidence for early aging in PWH comes from studies in corneal epithelial cells, monocyte, and immune dysfunction, and the emergence of frailty at an earlier age [ 6 , 7 , 17 ].…”

Social support moderates D-dimer and self-rated successful aging within people with HIV and older adults

“…These findings are interesting because intuitively, one would predict these more vulnerable populations to continue to feel less successful as they decline physically. Especially in the context of living with HIV, where it would be expected that greater susceptibility to physical illness, accelerated physical decline, social stigma, discrimination, and survivors' guilt might lead persons to feel less successful as they physically become less well (Emlet, 2016;Khoury et al, 2017;Meanley et al, 2019). Yet, the data revealed a strong reverse relationship.…”

HIV infection is an independent risk factor for decreased 6-minute walk test distance

“…There is conflicting evidence as to the independent relationship of HIV to physical function as measured by 6-MWD. During the ART era, two studies in primarily male PLWH and matched HIV-uninfected individuals did not show an independent effect of HIV on 6-MWD [9, 29]. A cross-sectional analysis of self-reported data from the Veterans Aging Cohort Study found very modest difference in physical function between PLWH and HIV-uninfected individuals.…”