Frailty in medically complex individuals with chronic HIV

Abstract

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.

Prevalence of Frailty and Prefrailty in People With Human Immunodeficiency Virus Aged 50 or Older: A Systematic Review and Meta-Analysis

“…Sixteen studies were conducted in the United States and Canada, 5 studies were conducted in the European Union, and 5 studies were conducted in Asia or other regions. Regarding HIV-related variables, the mean current CD4 cell count was reported in 18 of the 26 studies, ranging from 466 [ 37 ] to 673 cells/μL [ 36 ], and the mean nadir CD4 cell count was reported in 18 studies, ranging from 50 [ 33 ] to 208 cells/μL [ 40 ]. The percentage of patients with undetectable VL was reported in 19 studies, ranging from 69.5% [ 38 ] to 100% [ 19 , 40 ].…”

Multimorbidity networks associated with frailty among middle-aged and older people with HIV

“…Participants were from the National NeuroAIDS Tissue Consortium (NNTC), a longitudinal cohort constituted of participants at four sites: Texas NeuroAIDS Research Center (Galveston, Texas), National Neurological AIDS Bank (Los Angeles, California), Manhattan HIV Brain Bank (New York, New York), and California Neu-roAIDS Tissue Network (San Diego, California). NNTC participants have high rates of morbidity as criteria for entry includes a significant neurological or medical condition, including advanced HIV disease, significant cardiac disease, advanced liver or renal disease, cancers, or other imminent risk for mortality; age 60 years or older was recently added to the list of possible criteria for entry [19]. Participants undergo standardized visits with formal assessments of behavioral characteristics, medical and neurological conditions, medication use, virological and immunological parameters, and other clinical and laboratory data at 6-month or 12-month intervals; frailty assessments were introduced in 2014.…”

“…The frequencies of 12 common comorbidities in PWH [1,16,19,21,22] are shown for participants by frailty status in Table 2. As expected, all comorbidities were more prevalent in frail compared with robust participants, and incrementally more prevalent compared with prefrail participants.…”

“…Frailty is a strong predictor of adverse health effects including multimorbidity, hospitalization, disability, and mortality among middle-aged and older PWH on suppressive ART [14][15][16][17]. The relationship between frailty and multimorbidity is bidirectional, as multimorbidity also predicts increased odds of frailty [1,6,18,19]. Comorbidities associated with frailty among PWH include chronic obstructive pulmonary disease (COPD), cardiovascular, renal, and liver diseases, diabetes, depressive symptoms, and cognitive impairment [1,15,16,[19][20][21][22].…”

“…Comorbidities associated with frailty among PWH include chronic obstructive pulmonary disease (COPD), cardiovascular, renal, and liver diseases, diabetes, depressive symptoms, and cognitive impairment [1,15,16,[19][20][21][22]. Particular combinations of comorbidities may act synergistically to amplify odds of frailty in PWH, and effects of specific comorbidities on frailty risk are impacted by gender, behavioral/lifestyle factors, and other characteristics of the population [19,21,22]. Thus, network-based approaches have the potential to uncover unexpected relationships between diseases, and highlight shared mechanisms or environmental factors not otherwise considered [23].…”