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Masters MC, Tassiopoulos K, Bao Y, Wu K, Koletar SL, Rubin LH, Yang J, Overton ET, Letendre S, Brown TT, Erlandson KM, Palella FJ. Risk factors for progression from prediabetes to diabetes among older people with HIV. AIDS 2024; 38:1740-1748. [PMID: 38923420 PMCID: PMC11365760 DOI: 10.1097/qad.0000000000003970] [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: 06/28/2024]
Abstract
OBJECTIVE Risk factors for progression from prediabetes mellitus (pre-DM) to diabetes mellitus (DM) among people with HIV (PWH) receiving modern antiretroviral therapy (ART) require better characterization. DESIGN AIDS Clinical Trials Group (ACTG) A5322 (HAILO) was an observational cohort study of PWH ≥40 years old. Participants initiated ART through ACTG randomized clinical trials. METHODS We used Cox proportional hazards regression models to identify risk factors for development of DM among HAILO participants with pre-DM. RESULTS Among 1035 HAILO participants, 74 (7%) had pre-DM at entry and another 679 (66%) developed pre-DM during follow-up. Of 753 PWH with pre-DM, 167 (22%) developed DM. In multivariable models, the risk of developing DM was greater with higher BMI, lower CD4 count (≤200 cells/mm 3 ), hypertriglyceridemia, or higher waist circumference at pre-DM diagnosis ( P < 0.01). CONCLUSION Rates of pre-DM and progression to DM remain high among virally suppressed PWH receiving modern ART regimens. Traditional risks for DM, such as higher BMI or waist circumference, are associated with increased risk of incident DM among PWH with pre-DM. The association between lower CD4 + and progression to DM suggests a role for advanced immunodeficiency and inflammation. Further investigation of interventions aimed at preventing DM among PWH with pre-DM is needed. Optimizing prevention and treatment for DM may be an intervenable opportunity to improve long-term outcomes for PWH.
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Affiliation(s)
| | | | - Yajing Bao
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kunling Wu
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | - Edgar T Overton
- University of Alabama at Birmingham and ViiV Healthcare, Birmingham, Alabama
| | - Scott Letendre
- University of California, San Diego, San Diego, California
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2
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Russell ML, Justice A. Human Immunodeficiency Virus in Older Adults. Clin Geriatr Med 2024; 40:285-298. [PMID: 38521599 DOI: 10.1016/j.cger.2023.12.004] [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] [Indexed: 03/25/2024]
Abstract
As people with HIV live longer, they can experience increased incidence and earlier onset of chronic conditions and geriatric syndromes. Older people are also at substantially increased risk of delayed diagnosis and treatment for HIV. Increasing provider awareness of this is pivotal in ensuring adequate consideration of HIV testing and earlier screening for chronic conditions. In addition, evaluating patients for common geriatric syndromes such as polypharmacy, frailty, falls, and cognitive impairment should be contextualized based on how they present.
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Affiliation(s)
- Matthew L Russell
- Harvard University, Massachusetts General Hospital, 55 Fruit Street, Yawkey 2C, Boston, MA 02114, USA.
| | - Amy Justice
- Department of General Internal Medicine, Yale School of Medicine, Yale University, 950 Campbell Avenue, West Haven, CT 06516, USA
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3
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Yang C, Teh YE, Chua NGS, Lee KLS, Ng RQM. An overview of multimorbidity and polypharmacy in older people living with HIV. Geriatr Gerontol Int 2024; 24 Suppl 1:49-59. [PMID: 37940135 DOI: 10.1111/ggi.14717] [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: 09/06/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
The availability of effective antiretroviral therapy (ART) has revolutionized the care of people living with HIV (PLHIV). As a result, PLHIV now have a life expectancy comparable with that of the general population. PLHIV are increasingly confronted with age-related comorbidities and geriatric syndromes, including frailty and polypharmacy, which occur at a higher prevalence and set in at an earlier age compared with their uninfected counterparts. The underlying pathophysiology for multimorbidity and polypharmacy are multifactorial, multidimensional and complex. Therefore, regular review and optimization of risk factors to maintain physical function, social and psychological health is of utmost importance. With an ever-growing population of older PLHIV, there is a pressing need to provide holistic care to address these emerging issues. Accelerated aging observed in PLHIV suggests that early involvement of a multidisciplinary team, including geriatricians, and implementation of integrated models of care can potentially improve the care of older PLHIV, who are at increased risk of frailty and complex multimorbidity. This article reviews the current global situation, discusses the challenges involved and suggests approaches to deliver comprehensive care for older PLHIV. Geriatr Gerontol Int 2024; 24: 49-59.
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Affiliation(s)
- Chen Yang
- Department of Geriatric Medicine, Singapore General Hospital, Outram Road, Singapore
| | - Yii Ean Teh
- Department of Infectious Disease, Singapore General Hospital, Outram Road, Singapore
| | | | | | - Rachel Qiao Ming Ng
- Department of Geriatric Medicine, Singapore General Hospital, Outram Road, Singapore
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4
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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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5
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Byanova KL, Abelman R, North CM, Christenson SA, Huang L. COPD in People with HIV: Epidemiology, Pathogenesis, Management, and Prevention Strategies. Int J Chron Obstruct Pulmon Dis 2023; 18:2795-2817. [PMID: 38050482 PMCID: PMC10693779 DOI: 10.2147/copd.s388142] [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] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by airflow limitation and persistent respiratory symptoms. People with HIV (PWH) are particularly vulnerable to COPD development; PWH have demonstrated both higher rates of COPD and an earlier and more rapid decline in lung function than their seronegative counterparts, even after accounting for differences in cigarette smoking. Factors contributing to this HIV-associated difference include chronic immune activation and inflammation, accelerated aging, a predilection for pulmonary infections, alterations in the lung microbiome, and the interplay between HIV and inhalational toxins. In this review, we discuss what is known about the epidemiology and pathobiology of COPD among PWH and outline screening, diagnostic, prevention, and treatment strategies.
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Affiliation(s)
- Katerina L Byanova
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Abelman
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Huang
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Enogela EM, Jones R, Buford TW, Vance DE, Fazeli PL. Cardiometabolic Diseases and Quality-of-Life Outcomes in Adults With HIV in the Deep South: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:171-181. [PMID: 36576513 DOI: 10.1097/jnc.0000000000000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/27/2022] [Indexed: 12/29/2022]
Abstract
ABSTRACT The role of cardiometabolic diseases (CMDs) on physical health-related quality of life (P-HRQoL) and quality of sleep was examined among 261 PLWH ≥40 years, recruited from a university-affiliated HIV clinic in the Deep U.S. South. Using a cross-sectional study design, participants completed the Medical Outcomes Study HIV Health Survey (MOS-HIV; P-HRQoL) and Pittsburgh Sleep Quality Index. The overall prevalence of self-reporting ≥1 CMD was 64.4%. P-HRQoL scores were lower in PLWH with ≥1 CMD compared with those with no CMDs (45.53 ± 11.54 vs. 49.67 ± 10.77, p <.01). Poor sleep quality was higher among participants with ≥1 CMD compared with those with no CMDs (9.28 ± 4.42 vs. 7.26 ± 4.17, p <.01). Each additional CMD resulted in a 1.83-point decrease in P-HRQoL and 0.74-point increase in poor sleep quality scores. Interventions that focus on targeting these quality-of-life domains in PLWH with CMDs are needed.
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Affiliation(s)
- Ene M Enogela
- Ene M. Enogela, MPH, is an Epidemiology PhD Student, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. Raymond Jones, PhD, is an Assistant Professor, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA. Thomas W. Buford, PhD, is a Professor, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA, and is also affiliated with the Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA. David E. Vance, PhD, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Meng L, Chen D, Hu P, Yao M, Zhou C, Li X. A moderated mediation analysis of depression and age on the relationship between resilience and frailty among HIV-positive adults. Front Public Health 2023; 11:1128309. [PMID: 37033029 PMCID: PMC10077968 DOI: 10.3389/fpubh.2023.1128309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background Given the continuing challenges frailty poses among people living with human immunodeficiency virus (HIV) (PLHIV), accumulating evidence suggests that frailty is linked to psychological factors. However, the mutual influences of resilience, depression, and frailty have not yet been clarified. This study aimed to identify the potential mechanistic pathway through which psychological factors mitigate frailty. Methods Data were collected from June to August 2019 by trained investigators through face-to-face interviews with 375 HIV-positive Chinese adults. Each participant completed structured questionnaires to collect data in respect of their socio-demographic characteristics, and levels of frailty, depression, and resilience. These assessment measures included a self-designed questionnaire, the Tilburg Frailty Indicator (TFI), the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10), and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). SPSS PROCESS macro was used to analyze the mediation and moderated mediation models. Results The overall prevalence of frailty was 26.4%, and the prevalence of frailty among older and younger adults living with HIV was 22 and 31.4%, respectively. Mediation analysis showed that an association between resilience and frailty was mediated by depression, whereas resilience did not mediate the relationship between depression and frailty. Compared to physical frailty, depression was a stronger mediator of resilience to psychological frailty. We further found that age moderated the indirect effect of resilience on psychological frailty, with resilience being a stronger negative predictor of depression and depression being a stronger positive predictor of psychological frailty for older PLHIV than for younger PLHIV. Conclusion Lower levels of resilience and greater levels of depression may be significant risk factors for frailty among PLHIV. Levels of resilience influenced frailty directly and frailty was indirectly affected by depression. Therefore, it is recommended that PLHIV, especially older patients, should be encouraged to establish positive psychological coping strategies to slow the progression of frailty.
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Affiliation(s)
- Lijun Meng
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Chen
- Wuhan Health Information Center, Wuhan, Hubei, China
| | - Peiwu Hu
- Scientific Research Department, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Meng Yao
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, Hunan, China
| | - Cui Zhou
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xingli Li
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, Hunan, China
- *Correspondence: Xingli Li,
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Müller I, Mancinetti M, Renner A, Bridevaux PO, Brutsche MH, Clarenbach C, Garzoni C, Lenoir A, Naccini B, Ott S, Piquilloud L, Prella M, Que YA, Soccal PM, von Garnier C, Geiser TK, Funke-Chambour M, Guler S. Frailty assessment for COVID-19 follow-up: a prospective cohort study. BMJ Open Respir Res 2022; 9:9/1/e001227. [PMID: 35459694 PMCID: PMC9035838 DOI: 10.1136/bmjresp-2022-001227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/08/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Clinical Frailty Scale (CFS) is increasingly used for clinical decision making in acute care but little is known about frailty after COVID-19. OBJECTIVES To investigate frailty and the CFS for post-COVID-19 follow-up. METHODS This prospective multicentre cohort study included COVID-19 survivors aged ≥50 years presenting for a follow-up visit ≥3 months after the acute illness. Nine centres retrospectively collected pre-COVID-19 CFS and prospectively CFS at follow-up. Three centres completed the Frailty Index (FI), the short physical performance battery (SPPB), 30 s sit-to-stand test and handgrip strength measurements. Mixed effect logistic regression models accounting for repeated measurements and potential confounders were used to investigate factors associated with post-COVID-19 CFS. Criterion and construct validity were determined by correlating the CFS to other concurrently assessed frailty measurements and measures of respiratory impairment, respectively. RESULTS Of the 288 participants 65% were men, mean (SD) age was 65.1 (9) years. Median (IQR) CFS at follow-up was 3 (2-3), 21% were vulnerable or frail (CFS ≥4). The CFS was responsive to change, correlated with the FI (r=0.69, p<0.001), the SPPB score (r=-0.48, p<0.001) (criterion validity) and with the St George's Respiratory Questionnaire score (r=0.59, p<0.001), forced vital capacity %-predicted (r=-0.25, p<0.001), 6 min walk distance (r=-0.39, p<0.001) and modified Medical Research Council (mMRC) (r=0.59, p<0.001). Dyspnoea was significantly associated with a higher odds for vulnerability/frailty (per one mMRC adjusted OR 2.01 (95% CI 1.13 to 3.58), p=0.02). CONCLUSIONS The CFS significantly increases with COVID-19, and dyspnoea is an important risk factor for post-COVID-19 frailty and should be addressed thoroughly.
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Affiliation(s)
- Ilena Müller
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Marco Mancinetti
- Department of Internal Medicine, Hopital cantonal de Fribourg, Fribourg, Switzerland
| | - Anja Renner
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | | | | | | | - Christian Garzoni
- Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese Moncucco, Lugano, Switzerland.,Department of Infectious Diseases, Inselspital University Hospital Bern, Bern, Switzerland
| | - Alexandra Lenoir
- Division of Pulmonary Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bruno Naccini
- Department of Pulmonary Medicine, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland
| | - Sebastian Ott
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland.,Department of Pulmonary Medicine, Sankt Claraspital AG, Basel, Switzerland
| | - Lise Piquilloud
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Maura Prella
- Division of Pulmonary Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Paola Marina Soccal
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneve, Switzerland
| | | | - Thomas K Geiser
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland.,Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland
| | - Manuela Funke-Chambour
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland.,Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland
| | - Sabina Guler
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland .,Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland
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