Prevalence and 1-year incidence of frailty among women with and without HIV in the Women's Interagency HIV Study

Fatukasi, Terra V.; Edmonds, Andrew; Gustafson, Deborah; Cole, Stephen R.; Edwards, Jessie K.; Bolívar, Héctor; Cohen, Mardge H.; Fischl, Margaret A.; Gange, Stephen J.; Konkle‐Parker, Deborah; Moran, Caitlin; Plankey, Michael; Sharma, Anjali; Tien, Phyllis C.; Adimora, Adaora A.

doi:10.1097/qad.0000000000002047

Cited by 10 publications

(15 citation statements)

References 15 publications

(18 reference statements)

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“…Finally, women in our cohort had greater odds of being frail than men, which is similar to general populations, where female sex is associated with frailty [32]. In the Women's Interagency HIV Study (WIHS), it has been suggested that social and behavioral risk factors are important in the occurrence of frailty [32]. The WIHS is not selected for medical morbidity, with an overall frailty prevalence of 10%, less than half of what is seen in the women of NNTC.…”

Section: Discussionsupporting

confidence: 80%

Frailty in medically complex individuals with chronic HIV

Morgello

Sherman

Ellis

et al. 2019

Aids

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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.

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Section: Discussionsupporting

confidence: 80%

Frailty in medically complex individuals with chronic HIV

Morgello

Sherman

Ellis

et al. 2019

Aids

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“…The size of the cohorts in each study ranged from 27 [ 35 ] to 1016 [ 32 ]. Two studies [ 28 , 41 ] consisted only of male participants, and 2 other studies [ 31 , 46 ] consisted of only female participants, whereas the rest used mixed-gender cohorts with the range of 6.4% [ 19 ] to 50% [ 43 ] female participants. The mean age of the cohorts ranged from 50.1 [ 38 ] to 61.3 years [ 47 ], although the exact mean age was not reported in 5 studies.…”

Section: Resultsmentioning

confidence: 99%

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

Yamada

Kobayashi

Condo

et al. 2022

Open Forum Infectious Diseases

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Background With effective antiretroviral therapy, there is an emerging population of adults aged 50 years or older with human immunodeficiency virus (HIV). Frailty is an increasingly recognized clinical state of vulnerability associated with disability, hospitalization, and mortality. However, there is a paucity of large studies assessing its prevalence in people with HIV (PWH) aged 50 or older. Methods PubMed was systematically searched for studies published between January 2000 and August 2020 reporting the prevalence of frailty in PWH aged 50 or older. The pooled prevalence of frailty and prefrailty was synthesized using a random-effects meta-analysis. Results Of the 425 studies identified, 26 studies were included in the analysis, with a total of 6584 PWH aged 50 or older. The included studies were published between 2012 and 2020, and all studies used the Fried frailty phenotype to define frailty. The overall pooled prevalence of frailty and prefrailty was 10.9% (95% confidence interval [CI], 8.1%–14.2%) and 47.2% (95% CI, 40.1%–54.4%), respectively. A high degree of heterogeneity was observed (I2 = 93.2%). In the subgroup analysis, HIV-related variables and other demographic variables were examined, and heterogeneity disappeared only in the group of a longer duration since HIV diagnosis (I2 = 0%). Conclusions The pooled prevalence of frailty and prefrailty defined by the Fried frailty phenotype was assessed in PWH aged 50 or older. Findings from this study quantified the proportion of this specific population with this common geriatric syndrome. Future studies identifying effective strategies for frailty screening and intervention are required for this vulnerable population.

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“…Participants were assessed with a modified Fried Frailty Phenotype used in previous WIHS studies [10,11,18] that were composed of five components: unintentional weight loss, fatigue, low physical activity, measured weakness per grip strength and slow gait speed. Unintentional weight loss was assessed using a yes/no response to the item, “Since your last visit, have you had unintentional weight loss of at least 10 pounds?” Fatigue was assessed using a yes/no response to the item, “During the past four weeks, as a result of your physical health, have you had difficulty performing your work or other activities (for example, it took extra efforts)?” Low physical activity was assessed using a yes/no response to the item, “Does your health now limit you in vigorous activities, such as running, lifting heavy objects or participating in strenuous sports?” Grip strength was assessed using a hand‐held dynamometer with maximum force from the dominant hand.…”

Section: Methodsmentioning

confidence: 99%

“…Frailty is prevalent among people with HIV, but there are limited data on food insecurity and frailty within the context of HIV [8‐13]. Frailty is commonly assessed using the Fried Frailty Phenotype criteria, composed of weight loss, exhaustion, physical inactivity, slow walking speed and weak grip strength.…”

Section: Introductionmentioning

confidence: 99%

“…Women are disproportionally impacted by food insecurity due to gender‐based inequality in access to and control over resources [1,25‐27]. Relative to men with and without HIV, women have more frequent frailty, as well as other geriatric syndromes associated with frailty, such as falls and fracture [8,10,11]. Evidence in older populations without HIV strongly suggests that the relationship between frailty and mortality is greater among women than among men [28].…”

Section: Introductionmentioning

confidence: 99%

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Food insecurity and frailty among women with and without HIV in the United States: a cross‐sectional analysis

et al. 2021

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Introduction Frailty is frequently observed among people with HIV, and food insecurity is associated with frailty in the general population. Evidence is scarce on the associations between food insecurity and frailty among women with HIV who may be particularly vulnerable to the impacts of food insecurity. The goal of this study was to assess associations between food insecurity and frailty among women with and without HIV. Methods There were 1265 participants from the Women’s Interagency HIV Study who participated in frailty assessments in 2017. Frailty was measured using the Fried Frailty Phenotype, and women were subsequently categorized as robust, pre‐frail or frail. Food insecurity was assessed using the U.S. Household Food Security Survey Module, with women categorized as having high, marginal, low or very low food security. Multinomial logistic regression models were conducted to examine cross‐sectional associations between food insecurity and frailty while adjusting for socio‐demographic, behavioural and HIV status covariates. Results and discussion Approximately one‐third (31.9%) of the women had marginal, low or very low food security, and the proportions of women who met the criteria for frailty or pre‐frailty were 55.6% and 12.4% respectively. In the adjusted model, the relative risk ratio (RRR) of frailty for women with very low food security versus women with high food security was 3.37 (95% CI [1.38 to 8.24], p < 0.01); the corresponding RRR of pre‐frailty was 3.63 (95% CI [1.76 to 7.51], p < 0.001). Higher annual household income was associated with lower RRRs of frailty or pre‐frailty ( p < 0.01). Similarly, older age was associated with more frequent frailty (RRR=1.06, 95% CI [1.03 to 1.09], p < 0.001). HIV serostatus was not significantly associated with either pre‐frailty (RRR=0.97, 95% CI [0.71 to 1.31]) or frailty (RRR=0.75, 95% CI [0.48 to 1.16]). Conclusions Very low food security was associated with more frequent frailty and pre‐frailty among women with and without for HIV. HIV serostatus was not associated with frailty.

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Prevalence and 1-year incidence of frailty among women with and without HIV in the Women's Interagency HIV Study

Cited by 10 publications

References 15 publications

Frailty in medically complex individuals with chronic HIV

Frailty in medically complex individuals with chronic HIV

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

Food insecurity and frailty among women with and without HIV in the United States: a cross‐sectional analysis

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