1. Predictors of Transition to Frailty in Middle-Aged and Older People With HIV: A Prospective Cohort Study.
- Author
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Lorenz DR, Mukerji SS, Misra V, Uno H, Gelman BB, Moore DJ, Singer EJ, Morgello S, and Gabuzda D
- Subjects
- Aged, Aging, Antiretroviral Therapy, Highly Active, Comorbidity, Diabetes Mellitus epidemiology, Female, Frailty epidemiology, HIV Infections drug therapy, HIV Infections epidemiology, Humans, Liver Diseases epidemiology, Male, Middle Aged, Prospective Studies, Pulmonary Disease, Chronic Obstructive epidemiology, United States epidemiology, Frail Elderly, Frailty diagnosis, HIV Infections complications
- Abstract
Background: People with HIV (PWH) have increased frailty risk at younger ages compared with the general population. Multimorbidity is associated with frailty, yet effects of specific comorbidities on transition to frailty in PWH are unknown., Setting: Prospective study of 219 PWH age 45 years or older in the National NeuroAIDS Tissue Consortium., Methods: Frailty status was categorized using Fried frailty phenotype criteria. Comorbidities [bone disease, cardiovascular disease, cerebrovascular disease, liver disease, renal disease, diabetes, chronic obstructive pulmonary disease (COPD), hypertension, obesity, cancers, neuropsychiatric conditions] were assessed from longitudinal data. Associations between baseline comorbidities and transition to frailty within 30 months were analyzed using Kaplan-Meier and Cox regression models. Grip strength was assessed using mixed-effects models., Results: At baseline, the median age was 61 years, 73% were male 98% were on antiretroviral therapy, 29% had ≥3 comorbidities, 27% were robust, and 73% were pre-frail. Cerebrovascular disease, diabetes, and COPD were independent predictors of transition to frailty within 30 months in models adjusted for age, sex, and multimorbidity (≥3 additional comorbidities) [hazard ratios (95% confidence intervals) 2.52 (1.29 to 4.93), 2.31 (1.12 to 4.76), and 1.82 (0.95 to 3.48), respectively]. Furthermore, cerebrovascular disease, diabetes, COPD, or liver disease co-occurring with multimorbidity was associated with substantially increased frailty hazards compared with multimorbidity alone (hazard ratios 4.75-7.46). Cerebrovascular disease was associated with decreased baseline grip strength (P = 0.0001), whereas multimorbidity, diabetes, and COPD were associated with declining grip strength (P < 0.10)., Conclusions: In older PWH, cerebrovascular disease, diabetes, COPD, or liver disease co-occurring with multimorbidity is associated with substantially increased risk of becoming frail within 30 months. Interventions targeting these comorbidities may ameliorate frailty and age-related functional decline in PWH., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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