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Abidi MZ, Umbleja T, Overton ET, Burdo T, Flynn JM, Lu MT, Taron J, Schnittman SR, Fitch KV, Zanni MV, Fichtenbaum CJ, Malvestutto C, Aberg JA, Fulda ES, Eckard AR, Manne-Goehler J, Tuan JJ, Ribaudo HJ, Douglas PS, Grinspoon SK, Brown TT, Erlandson KM. Cytomegalovirus IgG is Associated With Physical Function But Not Muscle Density in People With HIV. J Acquir Immune Defic Syndr 2024; 95:470-478. [PMID: 38180893 PMCID: PMC10947880 DOI: 10.1097/qai.0000000000003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Cytomegalovirus (CMV) seropositivity is associated with poor outcomes, including physical function impairment, in people without HIV. We examined associations between CMV IgG titer and physical function in virologically suppressed people with HIV (PWH). METHODS REPRIEVE is a double-blind randomized trial evaluating pitavastatin for primary prevention of atherosclerotic cardiovascular disease in PWH. This analysis focused on participants enrolled in a substudy with additional biomarker testing, imaging [coronary CT angiography], and physical function measures at entry. CMV IgG was measured using quantitative enzyme immunoassay, physical function by Short Physical Performance Battery, and muscle density and area by CT. Associations between CMV IgG (risk factor) and outcomes were evaluated using the partial Spearman correlation and linear and log-binomial regression. RESULTS Among 717 participants, 82% male, the median CMV IgG was 2716 (Q1, Q3: 807, 6672) IU/mL, all above the limit of quantification. Among 631 participants with imaging, there was no association between CMV IgG and CT-based muscle density or area, controlling for age (r = -0.03 and r = -0.01, respectively; P ≥ 0.38). Among 161 participants with physical function data, higher CMV IgG was associated with poorer overall modified Short Physical Performance Battery score ( P = 0.02), adjusted for age, nadir CD4, and high-sensitivity C-reactive protein. CONCLUSIONS Higher CMV IgG titer was associated with poorer physical function, not explained by previous immune compromise, inflammation, or muscle density or area. Further mechanistic studies are needed to understand this association and whether CMV-specific therapy can affect physical function in PWH.
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Affiliation(s)
- Maheen Z. Abidi
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO, USA
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edgar T. Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Tricia Burdo
- Department of Microbiology, Immunology, and Inflammation and Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Jacqueline M. Flynn
- Department of Microbiology, Immunology, and Inflammation and Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Michael T. Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jana Taron
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Medical Center – University of Freiburg, Germany
| | - Samuel R. Schnittman
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kathleen V. Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Markella V. Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Carl J. Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carlos Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, OH, USA
| | - Judith A. Aberg
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evelynne S. Fulda
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Allison Ross Eckard
- Departments of Pediatrics and Medicine, Divisions of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica J. Tuan
- Division of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Heather J. Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, U.S.A
| | - Steven K. Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO, USA
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Quaresma MVLDS, Vicente BM, Balchiunas RE, Ribeiro SML. Sarcopenia risk, sarcopenia-related quality of life, and associated factors in people living with human immunodeficiency virus (HIV): A web-based survey. Nutrition 2024; 120:112352. [PMID: 38306734 DOI: 10.1016/j.nut.2024.112352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/17/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES We aimed to screen for the risk of sarcopenia and sarcopenia-related quality of life and associated factors of people living with HIV (PLWH). RESEARCH METHODS AND PROCEDURES This nonprobabilistic web-based survey evaluated PLWH. The participants were invited directly from a university-based inpatient clinic and responded to a web questionnaire that included the SARC-F and SarQoL to screen people at risk of sarcopenia and their quality of life. People at risk of sarcopenia were defined by the proposed cutoff points for SARC-F (≥ 4 points), and SarQoL overall score was categorized according to the median. Moreover, we performed a logistic regression to investigate associations between HIV-, lifestyle-, and health-associated factors (i.e., physical activity, dietary pattern, sleep quality, gastrointestinal symptoms, HIV diagnosis, type, combinations, and duration of ART, smoking, drinking, BMI, and weight loss), and outcomes (SARC-F and SarQoL). RESULTS The sample comprised 202 PLWH, mainly middle-aged (50.6-60.5 y; n = 101). Only 5.9% (n = 12) are at risk of sarcopenia according to SARC-F, and only 17.3% (n = 35) exhibited lower sarcopenia-related quality of life according to SarQoL. In the multiple models, only the gastrointestinal symptoms increased the odds of sarcopenia risk (OR: 1.058; P = 0.01) and poor sarcopenia-associated quality of life (OR: 1.041; P = 0.013). CONCLUSIONS We verified that only 5.9% and 17.3% of PLWH are at risk of sarcopenia and presented lower sarcopenia-related quality of life, respectively. Only the gastrointestinal symptoms were associated with a risk of sarcopenia and lower sarcopenia-related quality of life, without significant differences between age groups.
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Affiliation(s)
- Marcus V L Dos Santos Quaresma
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil; Centro Universitário São Camilo, São Paulo, Brazil
| | | | - Roseli Espindola Balchiunas
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil; Centro Universitário São Camilo, São Paulo, Brazil
| | - Sandra M L Ribeiro
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil; Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, Brazil.
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Guaraldi G, Erlandson KM, Milic J, Landay AL, Montano MA. Can statin preventative treatment inform geroscience-guided therapeutics? Aging Cell 2023; 22:e13998. [PMID: 37830430 PMCID: PMC10726887 DOI: 10.1111/acel.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023] Open
Abstract
Potential senotherapeutic effect of statins may lead to prevention and reduction of frailty.
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Affiliation(s)
- Giovanni Guaraldi
- Modena HIV Metabolic ClinicUniversity of Modena and Reggio EmiliaModenaItaly
- Department of Surgical, Medical, Dental and Morphological SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of MedicineUniversity of Colorado‐Anshutz Medical CampusAuroraColoradoUSA
| | - Jovana Milic
- Modena HIV Metabolic ClinicUniversity of Modena and Reggio EmiliaModenaItaly
- Department of Surgical, Medical, Dental and Morphological SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Alan L. Landay
- Department of Internal MedicineRush UniversityChicagoIllinoisUSA
| | - Monty A. Montano
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
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Erlandson KM, Umbleja T, Lu MT, Taron J, Ribaudo HJ, Overton ET, Presti RM, Haas DW, Sax PE, Yin MT, Zhai BK, Louis R, Upadhyay N, Eslami P, Douglas PS, Zanni MV, Fitch KV, Fulda ES, Fichtenbaum CJ, Malvestutto CD, Grinspoon SK, Brown TT. Associations of Muscle Density and Area With Coronary Artery Plaque and Physical Function. J Acquir Immune Defic Syndr 2023; 94:174-184. [PMID: 37368931 PMCID: PMC10527277 DOI: 10.1097/qai.0000000000003244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/01/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE Skeletal muscle quality and mass are important for maintaining physical function during advancing age. We leveraged baseline data from Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) to evaluate whether paraspinal muscle density and muscle area are associated with cardiac or physical function outcomes in people with HIV (PWH). METHODS REPRIEVE is a double-blind randomized trial evaluating the effect of pitavastatin for primary prevention of major adverse cardiovascular events in PWH. This cross-sectional analysis focuses on participants who underwent coronary computed tomography at baseline. Lower thoracic paraspinal muscle density (Hounsfield units [HU]) and area (cm 2 ) were assessed on noncontrast computed tomography. RESULTS Of 805 PWH, 708 had paraspinal muscle measurements. The median age was 51 years and 17% were natal female patients. The median muscle density was 41 HU (male) and 30 HU (female); area 13.2 cm 2 /m (male) and 9.9 cm 2 /m (female). In adjusted analyses, greater density (less fat) was associated with a lower prevalence of any coronary artery plaque, coronary artery calcium score >0, and high plaque burden ( P = 0.06); area was not associated with plaque measures. Among 139 patients with physical function measures, greater area (but not density) was associated with better performance on a short physical performance battery and grip strength. CONCLUSIONS Among PWH, greater paraspinal muscle density was associated with a lower prevalence of coronary artery disease while greater area was associated with better physical performance. Whether changes in density or area are associated with changes in CAD or physical performance will be evaluated through longitudinal analyses in REPRIEVE.
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Affiliation(s)
- Kristine M Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jana Taron
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Faculty of Medicine, Department of Radiology, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Edgar T Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Rachel M Presti
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - David W Haas
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Department of Internal Medicine, Meharry Medical College, Nashville, TN
| | - Paul E Sax
- Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael T Yin
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Bingxue Kris Zhai
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Rochelle Louis
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Namrata Upadhyay
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Parastou Eslami
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Markella V Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kathleen V Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Evelynne S Fulda
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Carl J Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Carlos D Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, OH; and
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Sullivan EV, Zahr NM, Sassoon SA, Pohl KM, Pfefferbaum A. Postural instability in HIV infection: relation to central and peripheral nervous system markers. AIDS 2023; 37:1085-1096. [PMID: 36927610 PMCID: PMC10164071 DOI: 10.1097/qad.0000000000003531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
OBJECTIVES Determine the independent contributions of central nervous system (CNS) and peripheral nervous system (PNS) metrics to balance instability in people with HIV (PWH) compared with people without HIV (PWoH). METHODS Volumetric MRI (CNS) and two-point pedal discrimination (PNS) were tested as substrates of stance instability measured with balance platform posturography. DESIGN 125 PWH and 88 PWoH underwent balance testing and brain MRI. RESULTS The PWH exhibited stability deficits that were disproportionately greater with eyes closed than eyes open compared with PWoH. Further analyses revealed that greater postural imbalance measured as longer sway paths correlated with smaller cortical and cerebellar lobular brain volumes known to serve sensory integration; identified brain/sway path relations endured after accounting for contributions from physiological and disease factors as potential moderators; and multiple regression identified PNS and CNS metrics as independent predictors of postural instability in PWH that differed with the use of visual information to stabilize balance. With eyes closed, temporal volumes and two-point pedal discrimination were significant independent predictors of sway; with eyes open, occipital volume was an additional predictor of sway. These relations were selective to PWH and were not detected in PWoH. CONCLUSION CNS and PNS factors were independent contributors to postural instability in PWH. Recognizing that myriad inputs must be detected by peripheral systems and brain networks to integrate sensory and musculoskeletal information for maintenance of postural stability, age- or disease-related degradation of either or both nervous systems may contribute to imbalance and liability for falls.
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Affiliation(s)
- Edith V. Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Natalie M. Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
| | | | - Kilian M. Pohl
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
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Davey CH, Navis B, Webel AR, Jankowski C, Oliveira VH, Khuu V, Cook PF, Erlandson KM. Impact of Food Insecurity and Undernutrition on Frailty and Physical Functioning in Aging People With HIV in the United States. J Assoc Nurses AIDS Care 2023; 34:238-247. [PMID: 36752748 PMCID: PMC10159892 DOI: 10.1097/jnc.0000000000000395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT We conducted an observational cross-sectional study to explore whether food insecurity or undernutrition was associated with frailty or low physical functioning in aging persons with HIV (PWH). Forty-eight PWH aged 50 years and older were enrolled. Independent samples t -tests and chi-square tests were used to examine the relationship of food insecurity or undernutrition to frailty or physical function. Participants were 58.6 (±6.3) years old, 83% male, 77% White, 21% Hispanic. In total, 44% experienced food insecurity and 71% experienced undernutrition, whereas 23% were frail and 69% were prefrail. Food insecurity was associated with impaired total short physical performance battery score ( p = .02), impaired balance ( p = .02), slower chair rise time ( p = .03), and weight loss within 12 months ( p = .05). Undernutrition was related to female gender ( p = .01), worse frailty ( p = .04), and weaker grip strength ( p = .03). In this sample of undernourished and frail PWH, strong relationships between undernutrition and frailty were observed.
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Affiliation(s)
| | - Brianna Navis
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Allison R. Webel
- University of Washington, School of Nursing, Seattle, Washington, USA
| | - Catherine Jankowski
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Vincent Khuu
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paul F. Cook
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, Colorado, USA
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7
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Sullivan EV, Zahr NM, Sassoon SA, Pfefferbaum A. Aging Accelerates Postural Instability in HIV Infection: Contributing Sensory Biomarkers. J Neuroimmune Pharmacol 2022; 17:538-552. [PMID: 34997916 PMCID: PMC9262994 DOI: 10.1007/s11481-021-10039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/24/2021] [Indexed: 01/13/2023]
Abstract
People living with HIV infection (PWH) who are adequately treated pharmacologically are now likely to have a near normal life span. Along with this benefit of the aging HIV population are potential physical problems attendant to aging, including postural stability. Whether aging with HIV accelerates age-related liability for postural instability and what sensory factors contribute to imbalance were examined in 227 PWH and 137 people living without HIV (PWoH), age 25 to 75 years. A mixed cross-sectional/longitudinal design revealed steeper aging trajectories of the PWH than PWoH in sway path length, measured as center-of-pressure micro-displacements with a force platform while a person attempted to stand still. Sway paths were disproportionately longer for PWH than PWoH when tested with eyes closed than open. Multiple regression identified objective measures of sensory perception as unique predictors of sway path length, whereas age, sway path length, and self-reports of falls were predictors of standing on one leg, a common measure of ataxia. Knowledge about sensory signs and symptoms of imbalance in postural stability with and without visual information may serve as modifiable risk factors for averting instability and liability for falls in the aging HIV population.
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Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, MC5723, 401 Quarry Road, Stanford, CA, USA.
- Center for Health Sciences, SRI International, Menlo Park, CA, USA.
| | - Natalie M Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, MC5723, 401 Quarry Road, Stanford, CA, USA
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | | | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, MC5723, 401 Quarry Road, Stanford, CA, USA
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
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Kehler DS, Milic J, Guaraldi G, Fulop T, Falutz J. Frailty in older people living with HIV: current status and clinical management. BMC Geriatr 2022; 22:919. [PMID: 36447144 PMCID: PMC9708514 DOI: 10.1186/s12877-022-03477-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022] Open
Abstract
This paper will update care providers on the clinical and scientific aspects of frailty which affects an increasing proportion of older people living with HIV (PLWH). The successful use of combination antiretroviral therapy has improved long-term survival in PLWH. This has increased the proportion of PLWH older than 50 to more than 50% of the HIV population. Concurrently, there has been an increase in the premature development of age-related comorbidities as well as geriatric syndromes, especially frailty, which affects an important minority of older PLWH. As the number of frail older PLWH increases, this will have an important impact on their health care delivery. Frailty negatively affects a PLWH's clinical status, and increases their risk of adverse outcomes, impacting quality of life and health-span. The biologic constructs underlying the development of frailty integrate interrelated pathways which are affected by the process of aging and those factors which accelerate aging. The negative impact of sarcopenia in maintaining musculoskeletal integrity and thereby functional status may represent a bidirectional interaction with frailty in PLWH. Furthermore, there is a growing body of literature that frailty states may be transitional. The recognition and management of related risk factors will help to mitigate the development of frailty. The application of interdisciplinary geriatric management principles to the care of older PLWH allows reliable screening and care practices for frailty. Insight into frailty, increasingly recognized as an important marker of biologic age, will help to understand the diversity of clinical status occurring in PLWH, which therefore represents a fundamentally new and important aspect to be evaluated in their health care.
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Affiliation(s)
- D. Scott Kehler
- grid.55602.340000 0004 1936 8200Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS Canada ,grid.55602.340000 0004 1936 8200School of Physiotherapy, Faculty of Health, Dalhousie University, Room 402 Forrest Building 5869 University Ave, B3H 4R2, PO Box 15000 Halifax, NS Canada
| | - Jovana Milic
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tamas Fulop
- grid.86715.3d0000 0000 9064 6198Department of Medicine, Geriatric Division, Research Center On Aging, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Julian Falutz
- grid.63984.300000 0000 9064 4811Division of Geriatric Medicine, Division of Infectious Diseases, Comprehensive HIV Aging Initiative, McGill University Health Center, Montreal, QC Canada
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Crane HM, Ruderman SA, Whitney BM, Nance RM, Drumright LN, Webel AR, Willig AL, Saag MS, Christopoulos K, Greene M, Hahn AW, Eron JJ, Napravnik S, Mathews WC, Chander G, McCaul ME, Cachay ER, Mayer KH, Landay A, Austad S, Ma J, Kritchevsky SB, Pandya C, Achenbach C, Cartujano-Barrera F, Kitahata M, Delaney JA, Kamen C. Associations between drug and alcohol use, smoking, and frailty among people with HIV across the United States in the current era of antiretroviral treatment. Drug Alcohol Depend 2022; 240:109649. [PMID: 36215811 PMCID: PMC10088427 DOI: 10.1016/j.drugalcdep.2022.109649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/30/2022] [Accepted: 09/23/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine associations between frailty and drug, alcohol, and tobacco use among a large diverse cohort of people with HIV (PWH) in clinical care in the current era. METHODS PWH at 7 sites across the United States completed clinical assessments of patient-reported measures and outcomes between 2016 and 2019 as part of routine care including drug and alcohol use, smoking, and other domains. Frailty was assessed using 4 of the 5 components of the Fried frailty phenotype and PWH were categorized as not frail, pre-frail, or frail. Associations of substance use with frailty were assessed with multivariate Poisson regression. RESULTS Among 9336 PWH, 43% were not frail, 44% were prefrail, and 13% were frail. Frailty was more prevalent among women, older PWH, and those reporting current use of drugs or cigarettes. Current methamphetamine use (1.26: 95% CI 1.07-1.48), current (1.65: 95% CI 1.39-1.97) and former (1.21:95% CI 1.06-1.36) illicit opioid use, and former cocaine/crack use (1.17: 95% CI 1.01-1.35) were associated with greater risk of being frail in adjusted analyses. Current smoking was associated with a 61% higher risk of being frail vs. not frail (1.61: 95% CI 1.41-1.85) in adjusted analyses. CONCLUSIONS We found a high prevalence of prefrailty and frailty among a nationally distributed cohort of PWH in care. This study identified distinct risk factors that may be associated with frailty among PWH, many of which, such as cigarette smoking and drug use, are potentially modifiable.
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Stephanie A Ruderman
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Bridget M Whitney
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Robin M Nance
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Lydia N Drumright
- Department of Biobehavioral Nursing and Health Informatics, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Allison R Webel
- Department of Child, Family and Population Health Nursing, University of Washington, Health Sciences Building, Box 357260, 1959 NE Pacific Ave, Seattle, WA, USA.
| | - Amanda L Willig
- Department of Medicine | Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA.
| | - Michael S Saag
- Department of Medicine | Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA.
| | - Katerina Christopoulos
- School of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Meredith Greene
- School of Medicine, University of California San Francisco, 490 Illinois Street, San Francisco, CA 94158, USA.
| | - Andrew W Hahn
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, USA.
| | - Sonia Napravnik
- Department of Epidemiology, 130 Mason Farm Rd, 2101 Bioinformatics Building, Chapel Hill, NC 27599-7215, USA.
| | | | - Geetanjali Chander
- Department of Medicine, 600N. Wolfe Street, Carnegie, Baltimore, MD 21287, USA.
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 3400N. Charles St. Baltimore, MD 21218-2683, USA.
| | - Edward R Cachay
- Owen Clinic, University of California San Diego, UC San Diego Health System, USA.
| | - Kenneth H Mayer
- Fenway Health/The Fenway Institute, 1340 Boylston Street, Boston, MA 02215, USA.
| | - Alan Landay
- Rush University, 1735 W. Harrison St, Chicago, IL 60612, USA.
| | - Steven Austad
- Department of Biology, Campbell Hall, 1300 University Blvd, University of Alabama Birmingham, Birmingham, AL, USA.
| | - Jimmy Ma
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Gerontology & Geriatric Medicine, Stricht Center for Healthy Aging and Alzheimer's Prevention, 475 Vine Street, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Chintan Pandya
- Center for Population Health Information Technology, Wolfe Street, Baltimore, MD 21205, Johns Hopkins University, Baltimore, MD, USA.
| | - Chad Achenbach
- Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave # 1, Chicago, IL 60611, USA.
| | | | - Mari Kitahata
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Joseph Ac Delaney
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada.
| | - Charles Kamen
- Department of Surgery University of Rochester Medical Center Rochester, NY, USA.
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Krankowska DC, Załęski A, Wiercińska-Drapało A. Frailty and prefrailty in people living with HIV, with focus on women living with HIV. Int J STD AIDS 2022; 33:1106-1110. [PMID: 36217985 DOI: 10.1177/09564624221127744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the increasing lifespan of people living with HIV (PLWH), frailty and prefrailty are becoming topics which require more attention. The reciprocal interactions between chronic inflammation, comorbidities and frailty demonstrate the complex pathophysiology of frailty and its consequences. Female sex, HIV infection without antiretroviral treatment, reduced CD4 cell count, depression and cardiovascular disease are some of the risk factors for frailty among PLWH. Frailty predisposes to falls and can therefore lead to more frequent fractures, hospitalization and death, especially in women with osteoporosis. Continuous antiretroviral treatment, prevention of comorbidities such as depression and diagnosis of prefrailty are crucial interventions to slow the development of frailty. This review summarizes the literature on frailty in people living with HIV and discusses frailty management strategies in order to improve the health outcomes in women living with HIV.
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Affiliation(s)
- Dagny C Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, 37803Medical University of Warsaw, Poland.,Hospital for Infectious Diseases, Warsaw, Poland
| | - Andrzej Załęski
- Department of Infectious and Tropical Diseases and Hepatology, 37803Medical University of Warsaw, Poland.,Hospital for Infectious Diseases, Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Infectious and Tropical Diseases and Hepatology, 37803Medical University of Warsaw, Poland.,Hospital for Infectious Diseases, Warsaw, Poland
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11
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Erlandson KM, Fitch KV, McCallum SA, Ribaudo HJ, Overton ET, Zanni MV, Bloomfield GS, Brown TT, Fichtenbaum CJ, Bares S, Aberg JA, Douglas PS, Fulda ES, Santana-Bagur JL, Castro JG, Moran LE, Mave V, Supparatpinyo K, Ponatshego PL, Schechter M, Grinspoon SK. Geographical Differences in the Self-Reported Functional Impairment of People With Human Immunodeficiency Virus (HIV) and Associations With Cardiometabolic Risk. Clin Infect Dis 2022; 75:1154-1163. [PMID: 35165682 PMCID: PMC9525090 DOI: 10.1093/cid/ciac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We sought to explore multinational differences in functional status by global burden of disease (GBD) regions in the REPRIEVE cohort. METHODS REPRIEVE is a prospective, double-blind, randomized, placebo-controlled, multicenter, phase III primary cardiovascular prevention study of pitavastatin calcium vs placebo among people with human immunodeficiency virus (HIV, PWH) ages 40-75 on antiretroviral therapy (ART). GBD super regions were defined using World Health Organization classifications. Participants were categorized by impairment on the Duke Activity Status Instrument (DASI: none, some, moderate, severe). Logistic regression models examined risk factors and GBD regions associated with functional impairment. The association between functional impairment and cardiometabolic risk was also explored. RESULTS Of 7736 participants, the majority were from high-income countries (n = 4065), were male (65%), and had received ART for ≥ 10 years. The median DASI score was 58.2 (interquartile range [IQR] 50.2, 58.2); 36% reported at least some impairment. In adjusted analyses, functional impairment was significantly more frequent among participants from Southeast/East Asia. Other factors associated with greater impairment included female sex, Black race, older age, current/former smoking, higher body mass index, use of ART for ≥ 10 years, and select ART regimens; differences were seen in risks across GBD regions. Functional impairment was associated with increased cardiometabolic risk. CONCLUSIONS Over 1/3 of middle-aged and older PWH in a global cohort across diverse GBD regions demonstrate functional impairments. The associations between DASI and cardiometabolic risk suggest that a measure of functional status may improve risk prediction; these longitudinal associations will be further investigated over REPRIEVE trial follow-up.
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Affiliation(s)
| | - Kathleen V Fitch
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sara A McCallum
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Edgar T Overton
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Markella V Zanni
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Todd T Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Sara Bares
- Specialty Care Center, Nebraska Medical Center, Omaha, Nebraska, USA
| | - Judith A Aberg
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Evelynne S Fulda
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jose G Castro
- University of Miami Infectious Disease Research Unit At Jackson Memorial Hospital, Miami, Florida, USA
| | - Laura E Moran
- Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Medical College, Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | - Ponego L Ponatshego
- Gaborone Prevention/Treatment Trials, Princess Marina Hospital, Gaborone, Botswana
| | - Mauro Schechter
- Projeto Praça Onze Pesquisa Em Saúde, Cidade Nova, Rio de Janeiro, Brazil
| | - Steven K Grinspoon
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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12
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Zanella I, Zacchi E, Fornari C, Fumarola B, Antoni MD, Zizioli D, Quiros-Roldan E. An exploratory pilot study on the involvement of APOE, HFE, C9ORF72 variants and comorbidities in neurocognitive and physical performance in a group of HIV-infected people. Metab Brain Dis 2022; 37:1569-1583. [PMID: 35353274 PMCID: PMC8964929 DOI: 10.1007/s11011-022-00975-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
Cognitive decline of aging is modulated by chronic inflammation and comorbidities. In people with HIV-infection (PWH) it may also be affected by HIV-induced inflammation, lifestyle and long-term effects of antiretroviral therapies (ART). The role of genetics in the susceptibility to HIV-associated neurocognitive disorders (HAND) is not fully understood. Here we explored the possible relations among variants in 3 genes involved in inflammation and neurodegenerative disorders (APOE: ε2/ε3/ε4; HFE: H63D; C9ORF72: hexanucleotide expansions ≥ 9 repeats), cognitive/functional impairment (MiniMental State Examination MMSE, Clock Drawing Test CDT, Short Physical Performance Battery SPPB), comorbidities and HIV-related variables in a cohort of > 50 years old PWH (n = 60) with at least 10 years efficient ART. Patients with diabetes or hypertension showed significantly lower MMSE (p = .031) or SPPB (p = .010) scores, respectively, while no relations between HIV-related variables and cognitive/functional scores were observed. Patients with at least one APOEε3 allele had higher CDT scores (p = .019), APOEε2/ε4 patients showing the lowest scores in all tests. Patients with HFE-H63D variant showed more frequently hypertriglyceridemia (p = .023) and those harboring C9ORF72 expansions > 9 repeats had higher CD4+-cell counts (p = .032) and CD4% (p = .041). Multiple linear regression analysis computed to verify possible associations among cognitive/functional scores and all variables further suggested positive association between higher CDT scores and the presence of at least one APOEε3 allele (2,2; 95% CI [0,03 0,8]; p = .037), independent of other variables, although the model did not reach the statistical significance (p = .14). These data suggest that in PWH on efficient ART cognitive abilities and physical performances may be partly associated with comorbidities and genetic background. However, further analyses are needed to establish whether they could be also dependent and influenced by comorbidities and genetic background.
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Affiliation(s)
- Isabella Zanella
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy.
- Clinical Chemistry Laboratory, Cytogenetics and Molecular Genetics Section, Diagnostic Department, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy.
| | - Eliana Zacchi
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy
| | - Chiara Fornari
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy
| | - Benedetta Fumarola
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy
| | - Melania Degli Antoni
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy
| | - Daniela Zizioli
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
| | - Eugenia Quiros-Roldan
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy
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Kuniholm MH, Vásquez E, Appleton AA, Kingsley L, Palella FJ, Budoff M, Michos ED, Fox E, Jones D, Adimora AA, Ofotokun I, D'souza G, Weber KM, Tien PC, Plankey M, Sharma A, Gustafson DR. Cardiovascular risk score associations with frailty in men and women with or at risk for HIV. AIDS 2022; 36:237-347. [PMID: 34934019 PMCID: PMC8711611 DOI: 10.1097/qad.0000000000003107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. DESIGN We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). METHODS FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011-2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4+ cell count/μl, antiretroviral therapy, and HIV viral load. RESULTS There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) = 2.12, 95% confidence interval (CI):1.22-3.69] and MWH (aHR = 2.19, 95% CI: 1.33-3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR = 1.88, 95% CI: 1.48-2.39) and MWH (aHR = 1.59, 95% CI: 1.26-2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) = 1.43, 95% CI: 1.02-2.00] and WWH (aOR = 1.36, 95% CI: 1.08-1.71); however, high-risk FRS was not (seronegative: aOR = 1.03, 95% CI: 0.30-3.49; WWH: aOR = 0.86, 95% CI: 0.23-3.20). CONCLUSION Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.
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Affiliation(s)
- Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Budoff
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Ervin Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Deborah Jones
- Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Igho Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Gypsyamber D'souza
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kathleen M Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, and Department of Veterans Affairs, San Francisco, California
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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Abstract
PURPOSE OF REVIEW The HIV population is ageing with rising rates of frailty though strategies of how best to manage it remain ill-defined. It also remains unclear what the prevalence of frailty is within this cohort, how best to diagnose it and what factors are associated. RECENT FINDINGS The prevalence of frailty remains unclear because of heterogenous results. Routine screening in those 50+ is recommended and whilst the Fried Frailty Phenotype is currently preferred the Clinical Frailty Scale could be considered. No biomarkers are currently recommended. Looking at associated factors, HIV neurocognitive impairment and long-term alcohol usage has been shown to be associated with developing frailty whilst those who are frail have been shown to be less active and more likely to fall. NAFLD with fibrosis has been shown to be an indicator of metabolic age and the Pooled Cohort Equations has been shown to be more effective in diagnosing cardiovascular risk in frail people living with HIV. SUMMARY Whilst the prevalence of frailty differs between countries, with the addition of prefrailty, this represents a large proportion of people living with HIV. Services must ensure strategies are in place to support those living with HIV and frailty. Further longitudinal studies are required.
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Affiliation(s)
- Howell T Jones
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Tom Levett
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Tristan J Barber
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
- Institute for Global Health, UCL, London, Institute of Child Health, London, UK
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15
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Predictors of Transition to Frailty in Middle-Aged and Older People With HIV: A Prospective Cohort Study. J Acquir Immune Defic Syndr 2021; 88:518-527. [PMID: 34757975 DOI: 10.1097/qai.0000000000002810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 01/01/2023]
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.
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Abstract
OBJECTIVE People with HIV (PWH) have increased prevalence of multimorbidity and frailty at younger ages compared with the general population. This study investigated individual and combinatorial effects of neuropsychiatric and medical comorbidities as predictors of frailty in PWH. DESIGN Analysis of data from the National NeuroAIDS Tissue Consortium, a longitudinal observational cohort. METHODS Five hundred and twenty-four PWH over age 40 years were classified using Fried's Frailty criteria. Twelve comorbidities were documented from longitudinal data and associations between individual and co-occurring comorbidities with frailty were assessed using weighted network and logistic regression analyses. RESULTS At frailty assessment between 2015 and 2020, median age was 61 years, 76% were men, 94% were on antiretroviral therapy (ART), 73% had two or more comorbidities, 24% were frail, and 52% were prefrail. Among individual comorbidities, highest odds of frailty were in participants with depressive symptoms [adjusted odds ratio (aOR), 95% confidence interval (CI) 3.48 (2.22-5.46)], followed by bone disease and chronic obstructive pulmonary disease (COPD) [2.47 (1.28-4.72) and 2.13 (1.36-3.34), respectively]. Among co-occurring comorbidities, highest odds of frailty were in participants having depressive symptoms with diabetes, hypertension, or obesity [aORs (95% CIs) 5.29 (2.32-12.08), 5.21 (2.65-10.40), 4.85 (2.39-9.95), respectively], cognitive impairment with diabetes or renal disease [2.81 (1.38-5.68) and 2.53 (1.26-5.03), respectively], renal disease with cardiovascular disease [2.81 (1.32-6.01)], and diabetes with obesity [2.76 (1.39-5.45)]. CONCLUSION Co-occurrence of depressive symptoms, cognitive impairment, diabetes, or renal disease with other medical conditions substantially increases odds of frailty in older PWH. Identifying and treating these comorbidities may help to reduce functional decline with aging in PWH.
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17
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Frailty in Aging People Living With HIV: a matched controlled Study. J Acquir Immune Defic Syndr 2021; 88:305-309. [PMID: 34238822 DOI: 10.1097/qai.0000000000002759] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We compared the prevalence of frailty among aging People Living with HIV (PLHIV) with people without HIV from the ANS EP58 HAND 55-70 Study. METHODS Cross-sectional multicentric study which consecutively included 200 PLHIV and 1000 people without HIV from the French national CONSTANCES cohort, matched on age, sex and education level. PLHIV were aged 55-70 years, with a HIV viral load < 50 copies/mL and a lymphocyte T-CD4 level > 200 cells/µl for the last 24 and 12 months respectively. We measured frailty (>2 items) and pre-frailty (one or two items) using a proxy of the 5-item Fried score. Multivariate logistic regression was performed to assess the association between HIV and frailty/pre-frailty, adjusting for demographic, social, behavioural and comorbidity confounders. RESULTS Outcome measures were available for 192 PLHIV and 822 people without HIV. Median age was 62 years, and 84.9% were male. Among PLHIV, the median CD4 cell count was 645.5 cells/µl. Prevalence of frailty/pre-frailty was 5.73%/57.3% in PLHIV vs. 1.73%/52.2% in people without HIV, respectively. HIV was associated with pre-frailty/frailty (OR = 1.89 ; CI95% = 1.37 - 2.61), but after adjusting for social and behavioural factors and comorbidities, HIV was not significantly associated with pre-frailty/frailty (OR = 1.24; 95% CI = 0.84 - 1.81). In PLHIV only, frailty/prefrailty was associated with depressive symptomatology, kidney disease and time since HIV-infection. CONCLUSIONS Prevalence of frailty is increased in aging PLHIV with well controlled HIV-disease, but other factors than HIV are predominant, particularly depression and comorbidities.
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Dillon SM, Abdo MH, Wilson MP, Liu J, Jankowski CM, Robertson CE, Tuncil Y, Hamaker B, Frank DN, MaWhinney S, Wilson CC, Erlandson KM. A Unique Gut Microbiome-Physical Function Axis Exists in Older People with HIV: An Exploratory Study. AIDS Res Hum Retroviruses 2021; 37:542-550. [PMID: 33787299 PMCID: PMC8260890 DOI: 10.1089/aid.2020.0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Impairments in physical function and increased systemic levels of inflammation have been observed in middle-aged and older persons with HIV (PWH). We previously demonstrated that in older persons, associations between gut microbiota and inflammation differed by HIV serostatus. To determine whether relationships between the gut microbiome and physical function measurements would also be distinct between older persons with and without HIV, we reanalyzed existing gut microbiome and short chain fatty acid (SCFA) data in conjunction with previously collected measurements of physical function and body composition from the same cohorts of older (51-74 years), nonfrail PWH receiving effective antiretroviral therapy (N = 14) and age-balanced uninfected controls (N = 22). Associations between relative abundance (RA) of the most abundant bacterial taxa or stool SCFA levels with physical function and body composition were tested using HIV-adjusted linear regression models. In older PWH, but not in controls, greater RA of Alistipes, Escherichia, Prevotella, Megasphaera, and Subdoligranulum were associated with reduced lower extremity muscle function, decreased lean mass, or lower Short Physical Performance Battery (SPPB) scores. Conversely, greater RA of Dorea, Coprococcus, and Phascolarctobacterium in older PWH were associated with better muscle function, lean mass, and SPPB scores. Higher levels of the SCFA butyrate associated with increased grip strength in both PWH and controls. Our findings indicate that in older PWH, both negative and positive associations exist between stool microbiota abundance and physical function. Different relationships were observed in older uninfected persons, suggesting features of a unique gut-physical function axis in PWH.
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Affiliation(s)
- Stephanie M. Dillon
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mona H. Abdo
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Melissa P. Wilson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Jay Liu
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Catherine M. Jankowski
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles E. Robertson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yunus Tuncil
- Department of Food Science, Purdue University, West Lafayette, Indiana, USA
| | - Bruce Hamaker
- Department of Food Science, Purdue University, West Lafayette, Indiana, USA
| | - Daniel N. Frank
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha MaWhinney
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Cara C. Wilson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Erlandson KM, Piggott DA. Frailty and HIV: Moving from Characterization to Intervention. Curr HIV/AIDS Rep 2021; 18:157-175. [PMID: 33817767 PMCID: PMC8193917 DOI: 10.1007/s11904-021-00554-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW While the characteristics associated with frailty in people with HIV (PWH) have been well described, little is known regarding interventions to slow or reverse frailty. Here we review interventions to prevent or treat frailty in the general population and in people with HIV (PWH). RECENT FINDINGS Frailty interventions have primarily relied on nonpharmacologic interventions (e.g., exercise and nutrition). Although few have addressed frailty, many of these therapies have shown benefit on components of frailty including gait speed, strength, and low activity among PWH. When nonpharmacologic interventions are insufficient, pharmacologic interventions may be necessary. Many interventions have been tested in preclinical models, but few have been tested or shown benefit among older adults with or without HIV. Ultimately, pharmacologic and nonpharmacologic interventions have the potential to improve vulnerability that underlies frailty in PWH, though clinical data is currently sparse.
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Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, Division of Infectious Diseases, University of Colorado-Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA.
| | - Damani A Piggott
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA
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Erlandson KM. Physical Function and Frailty in HIV. TOPICS IN ANTIVIRAL MEDICINE 2020; 28:469-473. [PMID: 34107206 PMCID: PMC8224243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Aging is associated with declines in physical function that can be influenced by many factors, including HIV. These limitations may manifest as increased vulnerability to stressors, or frailty. Functional limitations and frailty can be used to guide clinical decisions, protect people from harm, and avoid strategies that are not likely to provide benefits. Such limitations could also serve as clinically relevant endpoints for some clinical trials. Interventions should ideally focus on early impairments that begin to occur in midlife, well before an individual becomes frail or experiences disabilities. Overall, physical activity is safe and effective in improving physical function, and counseling about physical activity should be a routine component of HIV care to increase the lifespan and healthspan of individuals with HIV. There are some promising pharmaceutical options, but more research is needed to determine the safety and long-term efficacy. This article summarizes an International Antiviral Society-USA (IAS-USA) webinar presented by Kristine M. Erlandson, MD, MS, on July 24, 2020. This webinar is available on demand at https://www.iasusa.org/courses/on-demand-webinar-2020-erlandson/.
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