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Sambou C, Pourette D, Debeaudrap P, Slama L, Katlama C, Cazanave C, Bonnet F, Meyer L, Allavena C. The burden of secrecy in the management of multimorbidity in older people living with HIV aged 70 and over. AIDS Care 2024:1-8. [PMID: 38976641 DOI: 10.1080/09540121.2024.2372723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024]
Abstract
The secrecy surrounding HIV continues to be a major concern for older people living with HIV (OPWH) despite their long-term experience of HIV and the presence of other chronic diseases. Our study aims to highlight how the secrecy surrounding HIV can affect the management of the other conditions. The results of this socio-anthropological sub-study of the ANRS EP66 SEPTAVIH study, which assesses frailty in OPWH, are based on in-depth interviews conducted with 20 OPWH with multimorbidities aged 70 years and over and 9 caregivers. Based on a cross-sectional thematic analysis, this study shows that HIV infection differs from other chronic diseases due to the secrecy and stigma associated with HIV. These specific issues associated with HIV complicate the lives of OPWH, depriving them of support from loved ones and forcing them to exclude their general practitioner from their care system. This then causes OPWH with multiple chronic diseases to become socially vulnerable and isolated. Interventions that support the sharing of information on HIV among OPWH and also among caregivers need to be identified as a matter of urgency in order to improve the lives and management of OPWH with multimorbidities.Trial Registration: ClinicalTrials.gov identifier: NCT03958786.
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Affiliation(s)
- C Sambou
- Bordeaux Population Health, University of Bordeaux, Bordeaux, France
- Les Afriques dans le Monde (LAM), Pessac, France
| | - D Pourette
- CEPED, Institut de Recherche pour le Développement, Paris Cité University, Paris, France
- UMR Espace-Dev Réunion, Fellow of Institut Convergences Migrations, France
| | - P Debeaudrap
- CEPED, Institut de Recherche pour le Développement, Paris Cité University, Paris, France
| | - L Slama
- Department of Internal and Geriatric Medicine, Montpelier University Hospital, Montpelier, France
| | - C Katlama
- Department of Infectious Diseases, Hôpital la Pitié-Salpêtrière, Paris, France
| | - C Cazanave
- Department of Infectious Diseases, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - F Bonnet
- Department of Infectious Diseases, Hôpital Saint André, Bordeaux University Hospital, Bordeaux, France
| | - L Meyer
- CESP, INSERM U1018 - Hôpital du Kremlin-Bicêtre, Paris, France
| | - C Allavena
- Department of Infectious Diseases, Nantes University Hospital, University of Nantes, Nantes, France
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Achour J, Abulizi D, Makinson A, Arvieux C, Bonnet F, Goujard C, Lambert O, Slama L, Blain H, Meyer L, Allavena C. One-Year Frailty Transitions Among Persons With HIV Aged 70 Years or Older on Antiretroviral Treatment. Open Forum Infect Dis 2024; 11:ofae229. [PMID: 38966850 PMCID: PMC11222971 DOI: 10.1093/ofid/ofae229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/24/2024] [Indexed: 07/06/2024] Open
Abstract
Background People with HIV (PWH) are aging. Frailty is an age-related condition predictive of hospitalization and mortality. Here, we assessed the frequency and factors associated with frailty transitions at 1-year follow-up in elderly PWH. Methods Five hundred eight PWH aged 70 years or older who were on antiretroviral treatment were included in the French multicenter SEPTAVIH study in 2019-2020. Participants were classified as robust, prefrail, or frail according to Fried frailty phenotype at baseline and at 1 year. Logistic regression models were used to evaluate socioeconomic and medical factors associated with transition between frailty states. Models were adjusted for gender, age at baseline, education, and period of HIV diagnosis (before vs after 1996). Results Seventeen PWH died during the 1-year follow-up. Of the remaining 491 PWH (median age, 73 years), frailty status worsened for 18% of participants and improved for 14% at 1 year. Advanced age, baseline CD4+ T-cell count <350 cells/mm3, and type 2 diabetes were associated with transition from prefrailty to frailty (adjusted odds ratio [aOR], 1.10 per 1-year positive difference; 95% CI, 1.01-1.20; aOR, 3.05; 95% CI, 1.14-8.18; and aOR, 2.63; 95% CI, 1.05-6.57; respectively). Being female was associated with more frequent improvement from prefrailty to robustness (aOR, 2.50; 95% CI, 1.09-5.55). Conclusions Preventing frailty in elderly PWH is a long-term problem, beginning with the early diagnosis of HIV infection and the management of comorbidities.
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Affiliation(s)
- Jannett Achour
- INSERM CESP, U1018, Paris-Saclay University, Le Kremlin-Bicêtre, France
- Public Health Department, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Diane Abulizi
- INSERM CESP, U1018, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Alain Makinson
- Infectious Diseases Department, Montpellier University Hospital, Montpellier, France
| | - Cédric Arvieux
- Infectious Diseases Department, Rennes University Hospital, Rennes, France
| | - Fabrice Bonnet
- Internal Medicine Department, Bordeaux University Hospital, Bordeaux, France
| | - Cécile Goujard
- INSERM CESP, U1018, Paris-Saclay University, Le Kremlin-Bicêtre, France
- Internal Medicine Department, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Oriane Lambert
- INSERM CESP, U1018, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Laurence Slama
- Infectious Diseases Department, Hôtel-Dieu Hospital, AP-HP, Paris, France
| | - Hubert Blain
- Geriatrics Department, Montpellier University Hospital, Montpellier, France
| | - Laurence Meyer
- INSERM CESP, U1018, Paris-Saclay University, Le Kremlin-Bicêtre, France
- Public Health Department, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Clotilde Allavena
- INSERM, EA1413, Nantes, France
- Infectious Diseases Department, Nantes University Hospital, Nantes, France
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Dominguez-Dominguez L, Campbell L, Barbini B, Fox J, Nikiphorou E, Goff L, Lempp H, Tariq S, Hamzah L, Post FA. Associations between social determinants of health and comorbidity and multimorbidity in people of black ethnicities with HIV. AIDS 2024; 38:835-846. [PMID: 38265411 PMCID: PMC10994070 DOI: 10.1097/qad.0000000000003848] [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: 09/08/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Social determinants of health (SDH) are important determinants of long-term conditions and multimorbidity in the general population. The intersecting relationship between SDH and multimorbidity in people with HIV remains poorly studied. DESIGN A cross-sectional study investigating the relationships between eight socio-economic parameters and prevalent comorbidities of clinical significance and multimorbidity in adults of African ancestry with HIV aged 18-65 years in South London, UK. METHODS Multivariable logistic regression analysis was used to evaluate associations between SDH and comorbidities and multimorbidity. RESULTS Between September 2020 and January 2022, 398 participants (median age 52 years, 55% women) were enrolled; 85% reported at least one SDH and 72% had at least one comorbidity. There were no associations between SDH and diabetes mellitus or kidney disease, few associations between SDH (job and food insecurity) and cardiovascular or lung disease, and multiple associations between SDH (financial, food, housing and job insecurity, low educational level, social isolation, and discrimination) and poor mental health or chronic pain. Associations between SDH and multimorbidity mirrored those for constituent comorbidities. CONCLUSION We demonstrate strong associations between SDH and poor mental health, chronic pain and multimorbidity in people of black ethnicities living with HIV in the UK. These findings highlight the likely impact of enduring socioeconomic hardship in these communities and underlines the importance of holistic health and social care for people with HIV to address these adverse psychosocial conditions.
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Affiliation(s)
| | - Lucy Campbell
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust
- HIV Research Group
| | - Birgit Barbini
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust
- HIV Research Group
| | - Julie Fox
- Department of Infectious Diseases, King's College London
- Guy's and St Thomas’ Hospital NHS Foundation Trust
| | - Elena Nikiphorou
- Department of Rheumatology, Kings College Hospital NHS Foundation Trust
- Centre for Rheumatic Diseases
| | - Louise Goff
- Department of Nutritional Sciences, King's College London, London
- Leicester Diabetes Research Centre, Leicester
| | | | | | - Lisa Hamzah
- St George's Healthcare NHS Foundation Trust, London, UK
| | - Frank A. Post
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust
- HIV Research Group
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Kundura L, Cezar R, Gimenez S, Pastore M, Reynes C, Sotto A, Reynes J, Allavena C, Meyer L, Makinson A, Corbeau P. Immune profiles of pre-frail people living with HIV-1: a prospective longitudinal study. Immun Ageing 2024; 21:20. [PMID: 38481213 PMCID: PMC10935995 DOI: 10.1186/s12979-024-00416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND People living with HIV (PLWH) are at risk of frailty, which is predictive for death. As an overactivity of the immune system is thought to fuel frailty, we characterized the immune activation profiles linked to frailty. METHODS We quantified twenty-seven activation markers in forty-six virological responders (four females and forty-two males; median age, 74 years; median duration of infection, 24 years; median duration of undetectability, 13 years), whose frailty was determined according to the Fried criteria. T cell and NK cell activation was evaluated by flow cytometry, using a panel of cell surface markers. Soluble markers of inflammation, and monocyte activation and endothelial activation were measured by ELISA. The participants' immune activation was profiled by an unsupervised double hierarchical clustering analysis. We used ANOVA p-values to rank immunomarkers most related to Fried score. A Linear Discriminant Analysis (LDA) was performed to link immune activation markers to frailty. RESULTS 41% of the participants were pre-frail, including 24% with a Fried score of 1, and 17% with a Fried score of 2. ANOVA identified the 14 markers of T cell, monocyte, NK cell, endothelial activation, and inflammation the most linked to Fried 3 classes. The LDA performed with these 14 markers was capable of discriminating volunteers according to their Fried score. Two out of the 5 immune activation profiles revealed by the hierarchical clustering were linked to and predictive of pre-frailty. These two profiles were characterized by a low percentage of CD4 T cells and a high percentage of CD8 T cells, activated CD4 T cells, CD8 T cells, and NK cells, and inflammation. CONCLUSIONS We identified a particular immune activation profile associated with pre-frailty in PLWH. Profiling participants at risk of developing frailty might help to tailor the screening and prevention of medical complications fueled by loss of robustness. Further studies will indicate whether this frailty signature is specific or not of HIV infection, and whether it also precedes frailty in the general population.
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Affiliation(s)
- Lucy Kundura
- Institute of Human Genetics, CNRS-Montpellier University UMR9002, 141 rue de la Cardonille, Montpellier, 34396, France
| | - Renaud Cezar
- Immunology Department, Nîmes University Hospital, Place du Pr Debré, Nîmes, 30029, France
| | - Sandrine Gimenez
- Institute of Human Genetics, CNRS-Montpellier University UMR9002, 141 rue de la Cardonille, Montpellier, 34396, France
| | - Manuela Pastore
- Institute of Functional Genomics UMR5203 and BCM, CNRS-INSERM-Montpellier University, 141 rue de la Cardonille, Montpellier, 34396, France
| | - Christelle Reynes
- Institute of Functional Genomics UMR5203 and BCM, CNRS-INSERM-Montpellier University, 141 rue de la Cardonille, Montpellier, 34396, France
| | - Albert Sotto
- Infectious and Tropical Diseases Department, Nîmes University Hospital, Nîmes, France
- Montpellier University, Montpellier, France
| | - Jacques Reynes
- Montpellier University, Montpellier, France
- Infectious and Tropical Diseases Department, Montpellier University Hospital, Montpellier, France
| | - Clotilde Allavena
- Service de Maladies Infectieuses, CHU de Nantes, Université de Nantes, Nantes, UE, 1413, France
| | - Laurence Meyer
- INSERM CESP U1018, Le Kremlin Bicêtre, France
- Department of Public Health and Epidemiology, Bicêtre Hospital, AP-HP, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Alain Makinson
- Montpellier University, Montpellier, France
- Infectious and Tropical Diseases Department, Montpellier University Hospital, Montpellier, France
| | - Pierre Corbeau
- Institute of Human Genetics, CNRS-Montpellier University UMR9002, 141 rue de la Cardonille, Montpellier, 34396, France.
- Immunology Department, Nîmes University Hospital, Place du Pr Debré, Nîmes, 30029, France.
- Montpellier University, Montpellier, France.
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Paddick SM, Mukaetova-Ladinska EB. Recent advances in HIV-associated neurocognitive disorders: a focus on older adults and sub-Saharan Africa. Curr Opin Psychiatry 2024; 37:87-93. [PMID: 38226543 DOI: 10.1097/yco.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
PURPOSE OF REVIEW We reviewed recent literature on prevalence and interventional approaches for cognitive impairment in the context of HIV infection alongside current controversies and challenges around its nomenclature, screening, and diagnosis. RECENT FINDINGS Prevalence estimates for HIV-associated neurocognitive disorder (HAND) indicate that HAND remains highly prevalent despite combination antiretroviral treatment (cART) widely used. The available data are heterogeneous, particularly in sub-Saharan Africa (SSA) where recent reviews indicate substantial heterogeneity, wide prevalence estimates and lack of data from the majority SSA countries, despite them currently experiencing the greatest burden worldwide of both HIV and HAND.Several alternative approaches to diagnosis and classification of cognitive impairment in HIV have been published, taking into account changing clinical phenotypes. SUMMARY Cognitive impairment remains a significant challenge in the care of people living with HIV despite advances in treatment. Ongoing controversies exist around nomenclature and classification, screening measures, and the phenotype and aetiology of observed impairments. Two current areas of research priority and focus include understanding current phenotypes of individuals living and ageing with treated HIV and differing levels of risk for HAND in these phenotypes, alongside the effects of commonly occurring comorbidities.The current evidence base for interventional approaches is limited, but growing. The most promising avenues appear to be multidisciplinary. These are currently focussed on high income settings rather than SSA where the majority of people living with HIV, and affected by cognitive impairment in the context of HIV, currently reside.
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Affiliation(s)
- Stella-Maria Paddick
- Newcastle University Translational and Clinical Medicine Institute
- Gateshead Health NHS Foundation Trust
| | - Elizabeta B Mukaetova-Ladinska
- School of Psychology and Visual Science, University of Leicester
- The Evington Centre, Leicester General Hospital, Leicester, UK
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Torres TS, Jesus JS, Arabe D, Guaraldo L, Lessa FS, Facchinetti LD, Estrela R, Veloso VG, Grinsztejn B, Cardoso SW. Frailty and health-related quality of life among older people living with HIV pre- and post-COVID-19 pandemic onset: A cross-sectional study. Braz J Infect Dis 2024; 28:103723. [PMID: 38369295 PMCID: PMC10904252 DOI: 10.1016/j.bjid.2024.103723] [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: 09/11/2023] [Revised: 12/30/2023] [Accepted: 01/24/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Antiretroviral therapy increased the survival and life expectancy of People living With HIV (PWH). Frailty-related syndromes among older PWH (aged 50+ years) may affect their Health-related Quality of Life (HQoL). Additionally, the COVID-19 pandemic has impacted health-related outcomes. This study aimed to estimate the prevalence of frailty and pre-frailty among older PWH, and to explore associations of HQoL with the study assessment period and frailty status. METHODS Cross-sectional study conducted pre- (23-Mar-2019 to 5-Mar-2020) and post-COVID-19 pandemic onset (23-Jun-2021 to 5-May-2022), among older PWH at INI-Fiocruz, the largest cohort of PWH in Rio de Janeiro, Brazil. We measured frailty using Fried assessment, consisting of five domains: unintentional weight loss; self-reported exhaustion, weakness, slow walking speed, low physical activity. HQoL was assessed using the ACTG SF-21, which contains 21 questions divided into 8 domains. We used Chi-Square test, Fisher's exact test, Kruskal-Wallis and ranksum test for comparisons. RESULTS We included 250 older PWH: 109 (43.6 %) pre- and 141 (56.4 %) post-COVID-19 pandemic onset. Median age was 60-years (IQR: 55‒64). Most self-identified as cisgender men 152 (60.8 %), Pardo/Black 146 (58.4 %), with completed secondary education or less 181 (72.7 %) and low income 132 (52.8 %). Overall, prevalence of frailty and pre-frailty were 9.2 % (95 % CI: 8.1‒10.3) and 61.6 % (95 % CI: 54.0‒69.2). Prevalence of frailty in the pre- and pos-COVID-19 pandemic periods were 7.3 % and 10.6 % (p = 0.66). HQoL scores were lower among participants with frailty compared to those with non-frailty and pre-frailty in all eight domains, and among those included in the post-COVID-19 compared to pre-COVID-19 period for four domains. CONCLUSIONS We observed low prevalence of frailty, but high prevalence of pre-frailty among older PWH. Frailty status did not differ according to the COVID-19 assessment period. Assessment of frailty and HQoL should be incorporated in clinical practice for older PWH. Programs to reverse or prevent frailty should be implemented within the public health system.
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Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil.
| | - Jovanice S Jesus
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Daniel Arabe
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Lusiele Guaraldo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Flavia Serrao Lessa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Lívia Dumont Facchinetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Rita Estrela
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
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Wiechmann SL, Tejo AM, Inácio MVS, Mesas AE, Cabrera MAS. Prevalence of Frailty Phenotypes in Older People Living with HIV: A Cross-Sectional Study from Brazil. J Int Assoc Provid AIDS Care 2024; 23:23259582241241169. [PMID: 38715366 PMCID: PMC11078087 DOI: 10.1177/23259582241241169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/23/2023] [Accepted: 03/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Frailty may affect people living with HIV (PLHIV) prematurely. Fried's frailty phenotype, composed of 5 criteria, is one of the most used instruments for its assessment. This study aimed to determine the prevalence of these criteria among PLHIV classified as prefrail and frail in Brazil. METHODS A cross-sectional study analyzed the prevalence of the Frailty Phenotype in Brazil with 670 individuals aged ≥ 50 years and undetectable viral load. RESULTS The prevalence of prefrail and frail individuals was 50.7% and 13.6%, respectively. A low level of physical activity was the most prevalent criterion (50.9%). Except for unintentional weight loss, all other criteria were more prevalent among individuals with lower education levels. All criteria were more prevalent among individuals of lower socioeconomic status than among those of moderate or high status (P < .05). CONCLUSIONS A low level of physical activity was the component that most contributed to PLHIV being considered prefrail or frail.
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Affiliation(s)
- Susana Lilian Wiechmann
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
| | - Alexandre Mestre Tejo
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
| | - Manuel Victor Silva Inácio
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
| | - Arthur Eumann Mesas
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
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Wiechmann SL, Tejo AM, Inácio MVS, Mesas AE, Martínez-Vizcaíno V, Cabrera MAS. Frailty in people 50 years or older living with HIV: A sex perspective. HIV Med 2023; 24:1222-1232. [PMID: 37759412 DOI: 10.1111/hiv.13551] [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: 04/01/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To estimate prefrailty and frailty prevalence and associated factors in people living with HIV (PLHIV) from a sex perspective. METHODS Cross-sectional study on PLHIV at specialized public health centres in Brazil. Data were obtained from individuals aged ≥50 years using antiretroviral therapy (ART) and with an undetectable viral load through personal interviews, clinical evaluations and medical records. Frailty and prefrailty were characterized using the Fried Frailty Phenotype tool. Multinomial regression models were performed, and the associated factors were selected through the backward stepwise method. RESULTS Among 670 patients, 373 men and 297 women were included. The prevalence of frailty and prefrailty was significantly higher for women (16.2% and 56.2%, respectively) than for men (11.5% and 46.4%, respectively). Low socioeconomic and educational level, multimorbidity, depression, subjective cognitive complaints, and low scores on the Mini-Mental State Exam (MMSE) were associated (P < 0.05) with frailty for both sexes. However, in the sex-specific analysis, while smoking (OR = 3.66, 95% CI: 1.58-8.48) and a history of low adherence to ART (OR = 3.10, 95% CI: 1.33-7.23) were associated with frailty in men, depression (OR = 3.39, 95% CI: 1.36- 8.44) and the absence of functional dentition (OR = 3.77, 95% CI: 1.36- 10.43) were associated with frailty in women. CONCLUSIONS This study adds self-reported cognitive complaints as a potential predictor of frailty in both sexes and supports the known deleterious effect of multimorbidity on frailty in adults living with HIV. Furthermore, it suggests that other possible predictors, such as depression, oral health status and adherence to ART, may be sex-specific.
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Affiliation(s)
- Susana Lilian Wiechmann
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
| | - Alexandre Mestre Tejo
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
| | - Manuel Victor Silva Inácio
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
| | - Arthur Eumann Mesas
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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9
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Makinson A, Allavena C, Abulizi X, Slama L, Cases A, Trouillet MB, Martin-Blondel G, Geny C, Leclercq P, Cazanave C, Bonnet F, Naqvi A, David-Chevallier P, Arvieux C, Katlama C, Cabie A, Andriantsoanirina V, Blain H, Meyer L. Frailty and prefrailty phenotypes increase the odds of abnormal cognitive impairment screens in people with HIV. AIDS 2023; 37:2161-2168. [PMID: 37534690 DOI: 10.1097/qad.0000000000003681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Evaluate whether prefrail and frail people with HIV (PWH) have a higher risk of cognitive impairment on screens. METHODS Analysis of PWH aged 70 or older included in the ANRS EP66 SEPTAVIH cohort, on antiretroviral therapy for at least 12 months and with a MoCA test at enrolment. Adjusted risk of a Montreal Cognitive Assessment (MoCA) less than 26 was compared in frail/prefrail versus robust PWH. RESULTS A total of 503 PWH were enrolled with a median age of 73 years, IQR [71-77], 81.5% were male, 73.8% were French natives, 32.9% had low socio-economic status (EPICES score >30.2), and 41.3% were college graduates; 27.3% had a history of clinical AIDS. A total of 294 (58.5%) PWH had a MoCA score less than 26; 182 (36%) a MoCA score 23 or less. Frailty, prefrailty and robustness were found in 13.1, 63.6 and 23.3% participants, respectively. PWH with a MoCA less than 26 had a significantly higher risk of being frail/prefrail, this before [odds ratio (OR) = 2.31; 95% confidence interval (CI) 1.50-3.57], and after adjustment for confounders (OR = 1.80; 95% CI 1.07-3.01). The risk of being frail/prefrail in patients with a MoCA 23 or less was higher (adjusted OR = 2.75; 95% CI 1.46-5.16). Other factors independently associated with a MoCA less than 26 were older age, birth outside of France and a lower education level and being diabetic. CONCLUSION Abnormal MoCA screens were frequent in our cohort of PWH aged 70 or older with controlled HIV disease. Cognitive impairment should be systematically screened in frail/prefrail PWH. Frailty/prefrailty, diabetes and social factors, but not HIV-related factors, are important determinants of cognitive function in PWH with controlled disease.
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Affiliation(s)
- Alain Makinson
- Infectious Disease Department & INSERM U175- CHU La Colombière, University of Montpellier, Montpellier
| | - Clotilde Allavena
- Service de Maladies Infectieuses, UE 1413, CHU de Nantes, Université Nantes, Nantes
| | - Xian Abulizi
- Department of Public Health and Epidemiology, AP-HP, Bicêtre Hospital, Paris-Saclay University, & INSERM CESP U1018, Le Kremlin Bicêtre
| | - Laurence Slama
- Infectious Diseases Hôtel Dieu Hospital, APHP, Paris, France & Centre de Recherche épidémiologie et StatistiqueS Université de Paris Cité (CRESS-UMR1153), France
| | - Antoine Cases
- Department of Public Health and Epidemiology, AP-HP, Bicêtre Hospital, Paris-Saclay University, & INSERM CESP U1018, Le Kremlin Bicêtre
| | | | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse& Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III
| | - Christian Geny
- Department of Geriatrics, MUSE Montpellier University, Montpellier
| | - Pascale Leclercq
- Infectious Diseases Department, CHU de Grenoble Alpes, La Tronche
| | - Charles Cazanave
- Infectious Disease Department & UMR 5234 CNRS, Microbiologie Fondamentale et Pathogénicité, Antimicrobial Resistance in Mycoplasmas and Gram-Negative Bacteria, Bordeaux University Hospital
| | - Fabrice Bonnet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre & CHU de Bordeaux, Saint-André Hospital, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, Cedex
| | - Alissa Naqvi
- CHU de Nice Archet 1 Service de Maladies Infectieuses et Tropicales, Nice
| | - Perla David-Chevallier
- Service de médecine interne et d'immunologie clinique- AP-HP. Université Paris Saclay - Hôpital Béclère-Le Kremlin Bicêtre, FR
| | - Cédric Arvieux
- Département des Maladies Infectieuses, Centre Hospitalier et Universitaire de Rennes, Rennes
| | - Christine Katlama
- Sorbonne University Infectious Diseases Department APHP, Hôpital Pitié Salpêtrière, Paris
| | - André Cabie
- PCCEI, Univ Montpellier, INSERM, EFS, Univ Antilles, Montpellier, France, CIC Antilles Guyane, INSERM CIC1424, Fort-de-France, France
| | - Valérie Andriantsoanirina
- Department of Public Health and Epidemiology, AP-HP, Bicêtre Hospital, Paris-Saclay University, & INSERM CESP U1018, Le Kremlin Bicêtre
| | - Hubert Blain
- Department of Geriatrics, MUSE Montpellier University, Montpellier
| | - Laurence Meyer
- Department of Public Health and Epidemiology, AP-HP, Bicêtre Hospital, Paris-Saclay University, & INSERM CESP U1018, Le Kremlin Bicêtre
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10
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Falutz J, Lee D. Frailty and cognition in older people with HIV: recognizing the importance of geriatric syndromes. AIDS 2023; 37:2247-2249. [PMID: 37877280 DOI: 10.1097/qad.0000000000003715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Julian Falutz
- Division of Geriatrics and Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
| | - Daniel Lee
- Division of Infectious Diseases & Global Public Health, University of California, San Diego Health, San Diego, California, USA
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11
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Woods SP, Teixeira AL, Martins LB, Fries GR, Colpo GD, Rocha NP. Accelerated epigenetic aging in older adults with HIV disease: associations with serostatus, HIV clinical factors, and health literacy. GeroScience 2023; 45:2257-2265. [PMID: 36820957 PMCID: PMC10651616 DOI: 10.1007/s11357-023-00759-9] [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: 02/02/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
The prevalence of older persons with HIV (PWH) disease has increased considerably in the last 20 years, but our understanding of biological factors of aging and their clinical correlates among PWH remains limited. Study participants were 149 persons aged 50 and older, including 107 PWH and 42 seronegatives. All participants completed a blood draw, research medical evaluation, structured psychiatric interview, neurocognitive assessment, questionnaires, and measures of health literacy. Four epigenetic clocks were generated from stored blood samples using standardized laboratory methods. In regression models adjusting for sex and smoking status, PWH had significantly higher epigenetic aging acceleration values than seronegatives on all four indicators. Within the PWH sample, higher levels of epigenetic aging acceleration were moderately associated with lower current CD4 count, AIDS diagnoses, higher scores on the Veterans Aging Cohort Study Index, and lower telomere values. Higher epigenetic aging acceleration indices were also associated with lower health literacy among PWH. PWH experience accelerated aging as measured by a series of epigenetic clocks, which may be linked to immune compromise and risk of all-cause mortality. Health literacy may be a modifiable target for mitigating the risk of accelerated aging among older PWH.
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Affiliation(s)
- Steven Paul Woods
- Department of Psychology, University of Houston, 3695 Cullen Blvd., 126 Heyne Bldg. (Ste. 239d), Houston, Texas, 77004, USA.
| | - Antonio L Teixeira
- Department of Psychiatry & Behavioral Science, University of Texas Health Sciences Center at Houston, 1941 East Rd., Houston, Texas, 77054, USA
| | - Lais B Martins
- Department of Psychiatry & Behavioral Science, University of Texas Health Sciences Center at Houston, 1941 East Rd., Houston, Texas, 77054, USA
| | - Gabriel R Fries
- Department of Psychiatry & Behavioral Science, University of Texas Health Sciences Center at Houston, 1941 East Rd., Houston, Texas, 77054, USA
| | - Gabriela D Colpo
- Department of Neurology, University of Texas Health Sciences Center at Houston, 6431 Fannin St., Houston, Texas, 77030, USA
| | - Natalia P Rocha
- Department of Neurology, University of Texas Health Sciences Center at Houston, 6431 Fannin St., Houston, Texas, 77030, USA
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