Objective impairments of gait and balance in adults living with HIV-1 infection: a systematic review and meta-analysis of observational studies

Abstract

BackgroundGait and balance deficits are reported in adults with HIV infection and are associated with reduced quality of life. Current research suggests an increased fall-incidence in this population, with fall rates among middle-aged adults with HIV approximating that in seronegative elderly populations. Gait and postural balance rely on a complex interaction of the motor system, sensory control, and cognitive function. However, due to disease progression and complications related to ongoing inflammation, these systems may be compromised in people with HIV. Consequently, locomotor impairments may result that can contribute to higher-than-expected fall rates. The aim of this review was to synthesize the evidence regarding objective gait and balance impairments in adults with HIV, and to emphasize those which could contribute to increased fall risk.MethodsThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search of published observational studies was conducted in March 2016. Methodological quality was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Narrative synthesis of gait and balance outcomes was performed, and meta-analyses where possible.ResultsSeventeen studies were included, with fair to low methodological quality. All studies used clinical tests for gait-assessment. Gait outcomes assessed were speed, initiation-time and cadence. No studies assessed kinetics or kinematics. Balance was assessed using both instrumented and clinical tests. Outcomes were mainly related to center of pressure, postural reflex latencies, and timed clinical tests. There is some agreement that adults with HIV walk slower and have increased center of pressure excursions and -long loop postural reflex latencies, particularly under challenging conditions.ConclusionsGait and balance impairments exist in people with HIV, resembling fall-associated parameters in the elderly. Impairments are more pronounced during challenging conditions, might be associated with disease severity, are not influenced by antiretroviral therapy, and might not be associated with peripheral neuropathy. Results should be interpreted cautiously due to overall poor methodological quality and heterogeneity. Locomotor impairments in adults with HIV are currently insufficiently quantified. Future research involving more methodological uniformity is warranted to better understand such impairments and to inform clinical decision-making, including fall-prevention strategies, in this population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1682-2) contains supplementary material, which is available to authorized users.

Association between periodontitis and chronic kidney disease: Systematic review and meta‐analysis

“…NIH quality assessment tool was used to evaluate cross‐sectional studies. Inherent to the design, cross‐sectional studies automatically scored “not applicable” for question 6, 7, 10, 13 (Berner, Morris, Baumeister, & Louw, ). The studies were classified according to their quality: 0–3 low quality, 4–6 fair quality and 7–10 good quality.…”

Assessment of postural sway in people living with HIV/AIDS

“…Previous studies have identified that the postural sway of PLHA may be compromised by several factors, in addition to being a condition present in asymptomatic individuals 11,[13][14][15] . The scholars 6,15 have suggested that increased postural oscillation is associated with manifestations of HIV in the central nervous system (CNS).…”

“…This condition can, directly or indirectly, influence postural sway, specifically in more difficult tasks 11,12 .…”

“…However, the unfolding impacts of HIV and/or HAART on postural sway still do not present consensus 11 . From this perspective, understanding postural sway behavior in PLHA allows prophylaxis strategies to maintain functionality in tasks of daily living 11 .…”

“…However, the unfolding impacts of HIV and/or HAART on postural sway still do not present consensus 11 . From this perspective, understanding postural sway behavior in PLHA allows prophylaxis strategies to maintain functionality in tasks of daily living 11 . The postural sway of PLHA compared to non-HIV individuals may indicate pathological conditions that are still in an asymptomatic state 3,6 .…”