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Goldstein D, Kiplagat J, Taderera C, Whitehouse ER, Chimbetete C, Kimaiyo S, Urasa S, Paddick SM, Godfrey C. Person-centred care for older adults living with HIV in sub-Saharan Africa. Lancet HIV 2024:S2352-3018(24)00123-1. [PMID: 38996592 DOI: 10.1016/s2352-3018(24)00123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 07/14/2024]
Abstract
More than a fifth of people living with HIV in the US President's Emergency Plan for AIDS Relief-supported programmes are older individuals, defined as aged 50 years and older, yet optimal person-centred models of care for older adults with HIV in sub-Saharan Africa, including screening and treatment for geriatric syndromes and common comorbidities associated with ageing, remain undefined. This Position Paper explores the disproportionate burden of comorbidities and geriatric syndromes faced by older adults with HIV, with a special focus on women. We seek to motivate global interest in improving quality of life for older people with HIV by presenting available research and identifying research gaps for common geriatric syndromes, including frailty and cognitive decline, and multimorbidity among older people with HIV in sub-Saharan Africa. We share two successful models of holistic care for older people with HIV that are ongoing in Zimbabwe and Kenya. Lastly, we provide policy, research, and implementation considerations to best serve this growing population.
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Affiliation(s)
- Deborah Goldstein
- Office of HIV/AIDS, US Agency for International Development, Washington, DC, USA.
| | - Jepchirchir Kiplagat
- Moi University, College of Health Sciences, Eldoret, Kenya; USAID AMPATH Uzima, Eldoret, Kenya
| | | | | | | | - Sylvester Kimaiyo
- Moi University, College of Health Sciences, Eldoret, Kenya; USAID AMPATH Uzima, Eldoret, Kenya
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Stella-Maria Paddick
- Translational and Clinical Medicine Research Institute, Newcastle University, Newcastle, UK
| | - Catherine Godfrey
- Global Health Security and Diplomacy Bureau, Department of State, Washington, DC, USA
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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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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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Li N, Liu G, Gao H, Wu Q, Meng J, Wang F, Jiang S, Chen M, Xu W, Zhang Y, Wang Y, Feng Y, Liu J, Xu C, Lu H. Geriatric syndromes, chronic inflammation, and advances in the management of frailty: A review with new insights. Biosci Trends 2023; 17:262-270. [PMID: 37612125 DOI: 10.5582/bst.2023.01184] [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: 08/25/2023]
Abstract
As people age, geriatric syndromes characterized by frailty significantly impact both clinical practice and public health. Aging weakens people's immune functions, leading to chronic low-grade inflammation that ultimately contributes to the development of frailty. Effectively managing geriatric syndromes and frailty can help alleviate the economic burden of an aging population. This review delves into the intricate relationship among aging, infection-induced inflammation, chronic inflammation, and frailty. In addition, it analyzes various approaches and interventions to address frailty, such as smart rehabilitation programs and stem-cell treatments, offering promising solutions in this new era. Given the importance of this topic, further research into the mechanisms of frailty is crucial. Equally essential is the devising of relevant measures to delay its onset and the formulation of comprehensive clinical, research, and public health strategies to enhance the quality of life for elderly individuals.
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Affiliation(s)
- Niuniu Li
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Gaolin Liu
- Washington University in St. Louis, St. Louis, United States
| | - Hong Gao
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Qiang Wu
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Juan Meng
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Fei Wang
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Siwei Jiang
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Meixia Chen
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Wenhui Xu
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Yifan Zhang
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Yanjun Wang
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Yingqian Feng
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Juncai Liu
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Cheng Xu
- Department of Geriatric Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Hongzhou Lu
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
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Woldesemayat EM, St Clair-Sullivan N, Kassa A, Gari T, Gutema K, Chea N, Woubshet K, Bogale N, Assefa A, Vera J. Frailty status and associated factors among older PLHIV in Southern Ethiopia. PLoS One 2023; 18:e0284376. [PMID: 37093810 PMCID: PMC10124866 DOI: 10.1371/journal.pone.0284376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Studies addressing frailty are limited in the global south, including Ethiopia. We estimated the prevalence of frailty and associated factors among older people living with HIV (PLHIV) attending a large Comprehensive Specialized Hospital in southern Ethiopia. METHODS A systematic sample of 187 PLHIV and 187 HIV-negative controls > 50 years old were recruited between October 1 and November 30, 2021. Data on socio-demographic, behavioural and clinical characteristics were collected using a structured questionnaire. Frailty assessments were completed using the brief frailty instrument (B-FIT-2), which consists of 6 components. Scoring 5-6 points was frail, 2-4 points were pre-frail and below 2 was considered as non-frail. Logistic regression model was used to measure association between variables. RESULTS Median (IQR) age was 53 (50, 80) for PLWH and 59 (55-66) for controls. Prevalence of frailty was 9.1% for PLHIV Versus 5.9% for controls. A significant proportion of PLHIV was pre-frail; 141 (75.4%) compared to controls 110 (58.8%). Pre-frailty status was associated with HIV diagnosis (adjusted odds ratio (aOR) 4.2; 95% CI 1.8-9.9), low age (aOR 0.3; 95% CI 0.1-0.6), lower educational attainment (aOR 2.2; 95% CI 1.0-4.9), being farmer (aOR 3.2; 95% CI 1.0-10.2) and having high or low body mass index (BMI) (aOR 11.3; 95% CI 4.0-25.8). HIV diagnosis (aOR 9.7; 95% CI 1.6-56.8), age (aOR 0.2; 95% CI 0.1-0.7), lower educational attainment (aOR 5.2; 95% CI 1.5-18.2), single status (aOR 4.2; 95% CI 1.3-13.6), farmer (aOR 19.5; 95% CI 3.5-109.1) and high or low BMI (aOR 47.3; 95% CI 13.8-161.9) predicted frailty. CONCLUSION A high proportion of frailty and pre-frailty was observed in a cohort of older PLHIV attending care in Southern Ethiopia. Future research should focus on interventions targeting factors associated with frailty.
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Affiliation(s)
| | - Natalie St Clair-Sullivan
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Andargachew Kassa
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Taye Gari
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Keneni Gutema
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Nana Chea
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Kindie Woubshet
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Netsanet Bogale
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Amare Assefa
- College of Health Sciences, Jima University, Jima, Ethiopia
| | - Jaime Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
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Charumbira MY, Berner K, Louw QA. Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315636. [PMID: 36497710 PMCID: PMC9735592 DOI: 10.3390/ijerph192315636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 05/05/2023]
Abstract
A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aimed to systematically identify and map the most common functioning problems associated with health conditions that contribute most to disability in South Africa using the International Classification of Functioning, Disability and Health (ICF) framework. Peer-reviewed evidence published from January 2006 to December 2021 was systematically searched from five databases. Some 268 studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African adults (>18 years) related to 10 health conditions were included. A total of 130 different functioning problems were mapped to the ICF. The most prevalent problems (top 20) were related to mobility, pain, and mental health but spanned across several ICF domains and were mostly in patients at primary care. The high prevalence and wide range of functioning problems may be particularly burdensome on an already strained primary health care (PHC) system. This points towards targeted planning of innovative strategies towards strengthening rehabilitation service delivery at primary care to address these complexities where there is an inadequate rehabilitation workforce.
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7
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Li J, Chen X, Lin H, Yuan S, Shi R, Xu L, Qiao S, He C, Shen W, He N, Ding Y. Associations between
HIV
infection and frailty status and its individual components: Are frailty components disproportionally affected? HIV Med 2022; 24:533-543. [PMID: 36288971 DOI: 10.1111/hiv.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/10/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We aimed to examine whether HIV infection was independently associated with frailty status and its individual components. METHODS This cross-sectional investigation included people living with HIV (PLWH) and HIV-negative individuals from the baseline survey of the Comparative HIV and Aging Research in Taizhou (CHART) cohort, China. Frailty phenotype was based on five components: weight loss, low physical activity, exhaustion, weak grip strength and slow gait speed. Frailty was defined as the presence of at least three components, and prefrailty was defined as one or two components. Logistic regression models were used to analyse the factors associated with frailty and its components. RESULTS In all, 2475 people living with HIV (age 45.5 ± 14.9 years; 76.2% male) and 4948 HIV-negative individuals (age 45.5 ± 14.8 years; 76.3% male) were included. Among PLWH, median CD4 count was 395 cells/μL and 78% were currently on antiretroviral therapy (ART). Frailty and prefrailty were significantly more prevalent in PLWH (3.2% vs 1.9% and 32.9% vs 27.9%) overall and at ages 18-39 (1.4% vs 0.2% and 22.7% vs 19.0%), 40-59 (2.5% vs 0.9% and 30.9% vs 27.9%) and 60-90 years (8.4% vs 7.4% and 57.1% vs 45.8%). HIV infection was associated with frailty and prefrailty [adjusted odds ratio (aOR) = 1.48, 95% confidence interval (CI): 1.06-2.08; and aOR = 1.18, 95% CI: 1.05-1.33, respectively] after adjusting for confounding variables, but were strengthened with further adjustment for multimorbidity (aOR = 1.62, 95% CI: 1.14-2.28; and aOR = 1.22, 95% CI: 1.09-1.37), and were no longer significant with further adjustment for depressive symptoms and sleep disorders (aOR = 1.02, 95% CI: 0.71-1.46; and aOR = 1.06, 95% CI: 0.94-1.20). Among individual components, HIV infection was positively associated with weak grip strength and slow gait speed, but negatively associated with low physical activity and exhaustion in all the adjusted models described. CONCLUSIONS Frailty and prefrailty occur more often and earlier in PLWH. However, grip strength and gait speed are affected to a greater extent, highlighting their potential as screening and intervention targets to prevent or slow frailty among PLWH.
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Affiliation(s)
- Jing Li
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention Zhejiang China
| | - Haijiang Lin
- Taizhou City Center for Disease Control and Prevention Zhejiang China
| | - Shiying Yuan
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Ruizi Shi
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Lulu Xu
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Shijie Qiao
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Chunyan He
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention Zhejiang China
| | - Na He
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
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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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9
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Prynn JE, Dube A, Mwaiyeghele E, Mwiba O, Geis S, Koole O, Nyirenda M, Kuper H, Crampin AC. Self-reported disability in rural Malawi: prevalence, incidence, and relationship to chronic conditions. Wellcome Open Res 2021; 4:90. [PMID: 33336079 DOI: 10.12688/wellcomeopenres.15196.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in this low-income setting in Malawi. Methods: This study is nested in the Karonga Health and Demographic Surveillance Site in Malawi; the Washington Group questions were added to the annual survey in 2014. We used cross-sectional data from the 2014 survey to estimate the current prevalence of disability and examine associations of disability with certain chronic conditions. We then reviewed the incidence and resolution of disability over time using panel data from the 2015 survey. Results: Of 10,863 participants, 9.6% (95% CI 9.0-10.1%) reported disability in at least one domain. Prevalence was higher among women and increased with age. Diabetes and obesity were associated with disability among women, and diabetes was also associated with disability among men. Neither hypertension nor HIV were associated with disability. Participants reporting "no difficulty" or "can't do at all" for any domain were likely to report the same status one year later, whereas there was considerable movement between people describing "some difficulty" and "a lot of difficulty". Conclusions: Disability prevalence is high and likely to increase over time. Further research into the situation of this population is crucial to ensure inclusive policies are created and sustainable development goals are met.
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Affiliation(s)
- Josephine E Prynn
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.,University College London, London, UK
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Elenaus Mwaiyeghele
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Oddie Mwiba
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Steffen Geis
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.,London School of Hygiene & Tropical Medicine, London, UK.,Institute for Medical Microbiology and Hygiene, Phillips University of Marburg, Marburg, Germany
| | - Olivier Koole
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.,London School of Hygiene & Tropical Medicine, London, UK
| | - Moffat Nyirenda
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.,London School of Hygiene & Tropical Medicine, London, UK.,MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, London, UK
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.,London School of Hygiene & Tropical Medicine, London, UK
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10
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Felker G, Enel P, Petit N, Retornaz F, Darque A, Ravaux I. Frailty phenotype is associated with antiretroviral exposure among older persons living with HIV. Curr Opin HIV AIDS 2021; 16:271-277. [PMID: 34292176 DOI: 10.1097/coh.0000000000000695] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW This multicentre, cross-sectional study was carried out in the South of France to assess the association between frailty phenotype and antiretroviral therapy (ART) in older persons living with HIV (PLWHIV). Sociodemographic and HIV data, geriatric assessment, comorbidities, behavioral and age-related variables and the five frailty markers of Fried were recorded. Exposure to any pharmacological class of ART and all regimens were retrieved from medical records. RECENT FINDINGS The 509 PLWHIV analysed (72.7% male) received a mean of 6.01 ART regimens and 12.5 years exposure to ART. The prevalence of at least one frailty marker [frail and prefrail phenotype (FPFP)] was 66.4%. Duration of exposure to protease inhibitors and reverse transcriptase inhibitors, number of ART regimens and comorbidities, dyslipidaemia, cancer, depression, falls, disability and pain were significantly associated with FPFP by univariate analysis. In logistic regression multivariable analysis, independent predictors for FPFP were a large number of ART regimens, presence of cancer and pain. No significant association was found with HIV-related parameters neither with ART class and duration. SUMMARY A significant association was found between FPFP and a large number of different ART regimens among older PLWHIV. The burden of cancer and pain in these patients shows the importance of comprehensive care.
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Affiliation(s)
- Gwendoline Felker
- Assistance Publique Hôpitaux de Marseille, Public University Hospital
| | - Patricia Enel
- Assistance Publique Hôpitaux de Marseille, Public University Hospital
- Department of Public Health, Self-Perceived Health Assessment Research Unit EA3279, Aix-Marseille University
| | - Nathalie Petit
- Assistance Publique Hôpitaux de Marseille, Public University Hospital
| | - Frederique Retornaz
- Department of Public Health, Self-Perceived Health Assessment Research Unit EA3279, Aix-Marseille University
- Department of Internal Medicine and Infectious Diseases, European Hospital
| | - Albert Darque
- Assistance Publique Hôpitaux de Marseille, Public University Hospital
| | - Isabelle Ravaux
- Assistance Publique Hôpitaux de Marseille, Public University Hospital
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
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11
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Construct and Criterion-Related Validity of the Clinical Frailty Scale in Persons With HIV. J Acquir Immune Defic Syndr 2021; 88:110-116. [PMID: 34050103 DOI: 10.1097/qai.0000000000002736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The co-occurrence of frailty and cognitive impairment in older (50+ years) persons with HIV (PWH) is common and increases the risk of poor outcomes. In HIV clinics, the most commonly used frailty measures are the frailty phenotype (FP), which requires measuring grip strength and gait speed to implement, and the frailty index (FI) based on comprehensive health data collected on patients. We examined construct and criterion-related validity (as it predicts cognition) of the Clinical Frailty Scale (CFS), a less resource-intensive approach for assessing frailty, in relation to these more commonly used frailty assessments (FP and FI). SETTING/METHODS A total of 143 older (age 50+) PWH (mean age 57 years; 88% male) seen at the Southern Alberta Clinic underwent both frailty screening with the FP, CFS, and FI and neuropsychological testing. Mixed-effects regressions examined the associations between frailty status and cognition. RESULTS Concordance with the FP was slightly superior for the CFS than the FI. The FP and CFS had similar associations with domain-specific cognitive performance with frail PWH performing worse than nonfrail individuals on tests requiring manual dexterity (Trail Making Part A and B; Symbol Digit; and Grooved Pegboard; P values <0.05). Neither were associated with executive function, learning, or memory performance. The FI was associated with worse fluency, fine motor skills (Grooved Pegboard), and Trail Making Part A. CONCLUSION The CFS is a simple screening tool with good construct and criterion-related validity. It was associated with a similar pattern of cognitive deficits as the FP. If confirmed and the associations are extended to other clinically significant characteristics and outcomes, the CFS can be considered as an alternative to the FP and FI in assessing frailty in older PWH.
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12
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Prynn JE, Dube A, Mwaiyeghele E, Mwiba O, Geis S, Koole O, Nyirenda M, Kuper H, Crampin AC. Self-reported disability in rural Malawi: prevalence, incidence, and relationship to chronic conditions. Wellcome Open Res 2021; 4:90. [PMID: 33336079 PMCID: PMC7722531 DOI: 10.12688/wellcomeopenres.15196.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in this low-income setting in Malawi. Methods: This study is nested in the Karonga Health and Demographic Surveillance Site in Malawi; the Washington Group questions were added to the annual survey in 2014. We used cross-sectional data from the 2014 survey to estimate the current prevalence of disability and examine associations of disability with certain chronic conditions. We then reviewed the incidence and resolution of disability over time using panel data from the 2015 survey. Results: Of 10,863 participants, 9.6% (95% CI 9.0-10.1%) reported disability in at least one domain. Prevalence was higher among women and increased with age. Diabetes and obesity were associated with disability among women, and diabetes was also associated with disability among men. Neither hypertension nor HIV were associated with disability. Participants reporting “no difficulty” or “can’t do at all” for any domain were likely to report the same status one year later, whereas there was considerable movement between people describing “some difficulty” and “a lot of difficulty”. Conclusions: Disability prevalence is high and likely to increase over time. Further research into the situation of this population is crucial to ensure inclusive policies are created and sustainable development goals are met.
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Affiliation(s)
- Josephine E Prynn
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.,University College London, London, UK
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Elenaus Mwaiyeghele
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Oddie Mwiba
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Steffen Geis
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.,London School of Hygiene & Tropical Medicine, London, UK.,Institute for Medical Microbiology and Hygiene, Phillips University of Marburg, Marburg, Germany
| | - Olivier Koole
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.,London School of Hygiene & Tropical Medicine, London, UK
| | - Moffat Nyirenda
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.,London School of Hygiene & Tropical Medicine, London, UK.,MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, London, UK
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.,London School of Hygiene & Tropical Medicine, London, UK
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13
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Ambagtsheer RC, Moussa RK. Association of frailty with health service utilisation and health care expenditure in sub-Saharan Africa: evidence from Côte d'Ivoire. BMC Geriatr 2021; 21:446. [PMID: 34330220 PMCID: PMC8323268 DOI: 10.1186/s12877-021-02377-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background Frailty, a syndrome resulting in heightened risk of negative outcomes for older adults, is increasing across the globe. However, little is known about the health service impacts of frailty in low-income countries (LICs), and in particular, sub-Saharan Africa (SSA). This study explores the relationship between frailty and health service 1) utilisation and 2) expenditure within Côte d’Ivoire. Methods Participants aged 50 years and over participated in the Living Condition, Health and Resilience among the Elderly study. Frailty was assessed using a 30-item Frailty Index (FI). The association between frailty and self-reported health service utilisation was analysed for general practitioners (GPs), specialists, overnight hospitalisations, traditional practitioners and self-medication. Expenditure over the previous month included consulting, medications, hospitalisations and total expenditure. Results Among participants [n = 860, mean age (SD) = 61.8 (9.7) years, 42.9% female], 60.0% were frail, 22.8% pre-frail and 17.2% robust. The mean (SD) FI was 0.28 (0.17). Increased health service utilisation was associated with frailty for GP attendance, traditional practitioners and self-medication but not specialists or overnight hospitalisation. Pre-frailty and frailty were associated with increased total health service expenditure, with frailty also associated with aggregate consulting costs and medications. Conclusions Although frailty is associated with health service utilisation and expenditure in a variety of contexts, the study results suggest that such impacts may vary across the globe. The experience of frailty in LICs is likely to differ from that experienced elsewhere due to cultural traditions, attitudes to the health system, and accessibility, with more research needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02377-6.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia. .,Torrens University Australia, GPO Box 2025, Adelaide, SA, 5000, Australia.
| | - Richard K Moussa
- Ecole Nationale Supérieure de Statistique et d'Economie Appliquée, Abidjan, Côte d'Ivoire.,Institut National de la Statistique, Abidjan, Côte d'Ivoire
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14
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Vecchio A, Nakigozi G, Nakasujja N, Kisakye A, Batte J, Mayanja R, Anok A, Robertson K, Wawer MJ, Sacktor N, Rubin LH, Saylor D. Assessment, prevalence, and correlates of frailty among middle-aged adults with HIV in rural Uganda. J Neurovirol 2021; 27:487-492. [PMID: 33788138 DOI: 10.1007/s13365-021-00969-x] [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] [Received: 10/16/2020] [Revised: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
We investigated the prevalence and risk factors for frailty among people with HIV (PWH) in rural Uganda (n = 55, 47% male, mean age 44 years). Frailty was defined according to the Fried criteria with self-reported physical activity level replacing the Minnesota Leisure Time Activity Questionnaire. Alternate classifications for physical activity utilized were the sub-Saharan Africa Activity Questionnaire and the International Physical Activity Questionnaire. Eleven participants (19%) were frail. Frail participants were older (p < 0.001), less likely to be on antiretroviral therapy (p = 0.03), and had higher rates of depression (p < .001) and HIV-associated neurocognitive disorder (p = 0.003). Agreement between physical activity measures was sub-optimal. Prevalence of frailty was high among PWH in rural Uganda, but larger sample sizes and local normative data are needed.
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Affiliation(s)
- Alyssa Vecchio
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | | | | | | | - James Batte
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Kevin Robertson
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Maria J Wawer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ned Sacktor
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Leah H Rubin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Deanna Saylor
- Johns Hopkins University School of Medicine, Baltimore, USA
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15
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Montaño-Castellón I, Zeballos D, Gutiérrez-Peredo G, Netto E, Brites C. High Prevalence of Frailty and Prefrailty Status in Brazilian Patients Living with HIV. AIDS Res Hum Retroviruses 2021; 37:335-342. [PMID: 33353458 DOI: 10.1089/aid.2020.0113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Frailty is associated with an increased probability of serious adverse health outcomes in the geriatric general population. People living with HIV have a higher prevalence of frailty. However, the magnitude of this problem in younger patients in South America is unknown. We aimed to determine the prevalence and factors associated with frailty. This is a cross-sectional study from the Brazilian cohort HIV-AIDS (CoBRA) developed between March and November of 2018, on patients ≥18 years of age. Frailty phenotype was assessed by original Fried criteria. The results were analyzed using descriptive statistics, while identification of factors related to frailty was assessed by using multivariate logistic regression. We enrolled 231 patients; all, but 2 were on antiretroviral therapy (ART). Median age was 45.6 interquartile range (36.7-52.1) years, 136 (58.9%) were male, and 86.7% self-identified as non-white. Mean CD4 count was 660 (±345) cells/mm3 and 83.5% had undetectable HIV plasma viral load (<50 copies/mL). Prevalence of frailty and prefrailty was 10.4% and 52.4%, respectively. A CD4 count <200 cells/mm3, depression, low income, and use of third-line ART were variables significantly associated with a greater risk to present frail or prefrail status. Frailty prevalence increases with age and is an important health problem to health care in HIV aging patients. It requires proper strategies to its early detection, prevention, and management.
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Affiliation(s)
- Iris Montaño-Castellón
- Post-graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- LAPI—Research Laboratory of Infectious Diseases, University Hospital Professor Edgard Santos, School of Medicine, Salvador, Bahia, Brazil
| | - Diana Zeballos
- Post-graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Gabriel Gutiérrez-Peredo
- Post-graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Eduardo Netto
- Post-graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- LAPI—Research Laboratory of Infectious Diseases, University Hospital Professor Edgard Santos, School of Medicine, Salvador, Bahia, Brazil
| | - Carlos Brites
- Post-graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- LAPI—Research Laboratory of Infectious Diseases, University Hospital Professor Edgard Santos, School of Medicine, Salvador, Bahia, Brazil
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16
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Abstract
PURPOSE OF REVIEW Older adults account for the majority of people with HIV (PWH) in high-income countries and have increasingly complex clinical profiles related to premature aging. Frailty is an important geriatric syndrome affecting a minority of PHW. Frailty negatively affects PHW's clinical status and quality of life. This review will update care providers on the current state of frailty that limits the healthspan of PWH. RECENT FINDINGS Ongoing low-level HIV replication in treated PWH leads to immune activation and chronic inflammation contributing to the destabilization of normally autoregulated physiologic systems in response to environmental and biologic challenges characteristic of frailty. Understanding these underlying mechanisms will determine potential intervention options. Potentially reversible risk factors that promote progression to and reversion from the dynamic state of frailty are being studied and will help prevent frailty. Simple assessment tools and treatment strategies for frailty are being adapted for aging PWH. SUMMARY Insight into underlying biologic mechanisms and adapting proven geriatric principles of interdisciplinary care will inform the healthy aging of PWH.
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Affiliation(s)
- Julian Falutz
- Division of Geriatric Medicine, Comprehensive HIV Aging Initiative, Combined Viral Illness Service, Division of Infectious Diseases, McGill University Health Center, Quebec, Canada
| | - Fátima Brañas
- Division of Geriatrics, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Kristine M Erlandson
- Divisions of Infectious Diseases and Geriatric Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
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17
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Bristow C, George G, Hillsmith G, Rainey E, Urasa S, Koipapi S, Kisoli A, Boni J, Saria GA, Ranasinghe S, Joseph M, Gray WK, Dekker M, Walker RW, Dotchin CL, Mukaetova-Ladinska E, Howlett W, Makupa P, Paddick SM. Low levels of frailty in HIV-positive older adults on antiretroviral therapy in northern Tanzania. J Neurovirol 2021; 27:58-69. [PMID: 33432552 PMCID: PMC7921045 DOI: 10.1007/s13365-020-00915-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/01/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.
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Affiliation(s)
- Clare Bristow
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
| | - Grace George
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Grace Hillsmith
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Emma Rainey
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Sengua Koipapi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Japhet Boni
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | | | | | - Marcella Joseph
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Marieke Dekker
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Richard W Walker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Catherine L Dotchin
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Elizabeta Mukaetova-Ladinska
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.,Leicestershire Partnership NHS Trust, Leicester, UK
| | - William Howlett
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Philip Makupa
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | - Stella-Maria Paddick
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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18
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Prynn JE, Dube A, Mwaiyeghele E, Mwiba O, Geis S, Koole O, Nyirenda M, Kuper H, Crampin AC. Self-reported disability in rural Malawi: prevalence, incidence, and relationship to chronic conditions. Wellcome Open Res 2020; 4:90. [DOI: 10.12688/wellcomeopenres.15196.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in this low-income setting in Malawi. Methods: This study is nested in the Karonga Health and Demographic Surveillance Site in Malawi; the Washington Group questions were added to the annual survey in 2014. We used cross-sectional data from the 2014 survey to estimate the current prevalence of disability and examine associations of disability with certain chronic conditions. We then reviewed the incidence and resolution of disability over time using panel data from the 2015 survey. Results: Of 10,863 participants, 9.6% (95% CI 9.0-10.1%) reported disability in at least one domain. Prevalence was higher among women and increased with age. Diabetes and obesity were associated with disability among women, and diabetes was also associated with disability among men. Neither hypertension nor HIV were associated with disability. Participants reporting “no difficulty” or “can’t do at all” for any domain were likely to report the same status one year later, whereas there was considerable movement between people describing “some difficulty” and “a lot of difficulty”. Conclusions: Disability prevalence is high and likely to increase over time. Further research into the situation of this population is crucial to ensure inclusive policies are created and sustainable development goals are met.
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19
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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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20
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Prynn JE, Dube A, Mwaiyeghele E, Mwiba O, Geis S, Koole O, Nyirenda M, Kuper H, Crampin AC. Self-reported disability in rural Malawi: prevalence, incidence, and relationship to chronic conditions. Wellcome Open Res 2020; 4:90. [DOI: 10.12688/wellcomeopenres.15196.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in this low-income setting in Malawi. Methods: This study is nested in the Karonga Health and Demographic Surveillance Site in Malawi; the Washington Group questions were added to the annual survey in 2014. We used cross-sectional data from the 2014 survey to estimate the current prevalence of disability and examine associations of disability with certain chronic conditions. We then reviewed the incidence and resolution of disability over time using panel data from the 2015 survey. Results: Of 10,863 participants, 9.6% (95% CI 9.0-10.1%) reported disability in at least one domain. Prevalence was higher among women and increased with age. Diabetes and obesity were associated with disability among women, and diabetes was also associated with disability among men. Neither hypertension nor HIV were associated with disability. Participants reporting “no difficulty” or “can’t do at all” for any domain were likely to report the same status one year later, whereas there was considerable movement between people describing “some difficulty” and “a lot of difficulty”. Conclusions: Disability prevalence is high and likely to increase over time. Further research into the situation of this population is crucial to ensure inclusive policies are created and sustainable development goals are met.
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21
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Abstract
PURPOSE OF REVIEW Different factors contribute to the decreased overall long-term survival in treated people living with HIV (PLWH). This paper will review the state of physical frailty which limits successful aging in PLWH. RECENT FINDINGS Identifiable events on the continuum from clinical normality to heightened risk of adverse health outcomes contribute to frailty. These center on chronic inflammation leading to destabilization of autoregulated physiologic systems challenged by environmental and biologic challenges. Frailty assessment can inform the profile of aging PLWH at increased risk of common age-related disorders and geriatric syndromes. Biologic and psychosocial risk factors promoting progression to and reversion from a dynamic state of frailty are being investigated, allowing for preventative interventions to be considered. Insights gained from studying frail PLWH will help adapt an interdisciplinary geriatric model of health care for selected PLWH. This will improve the health and well-being of aging PLWH.
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Affiliation(s)
- Julian Falutz
- Division of Geriatrics, Director, Comprehensive HIV and Aging Initiative, McGill University Health Centre, Montreal, Quebec, Canada.
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22
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Justice AC, Tate JP. Strengths and Limitations of the Veterans Aging Cohort Study Index as a Measure of Physiologic Frailty. AIDS Res Hum Retroviruses 2020; 35:1023-1033. [PMID: 31565954 DOI: 10.1089/aid.2019.0136] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The Veterans Aging Cohort Study Index (VACS Index) is an index comprised of routine clinical laboratory tests that accurately and generalizably predicts all-cause mortality among those living with and without HIV infection. Increasing evidence supports its use as a measure of physiologic frailty among those aging with HIV because of its associations with frailty related outcomes including mortality, hospitalization, fragility fractures, serious falls, pneumonia, cognitive decline, delirium, and functional decline. In this review, we explore the evidence supporting the validity (construct, correlative, and predictive), responsiveness, and feasibility of the VACS Index as an early indicator of physiologic frailty. We also consider its limitations.
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Affiliation(s)
- Amy C. Justice
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Janet P. Tate
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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23
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Edwards A, Siedner MJ, Nash S, Neuman M, Danaviah S, Smit T, Gareta D, Kowal P, Seeley J. HIV serostatus, inflammatory biomarkers and the frailty phenotype among older people in rural KwaZulu-Natal, South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:177-185. [PMID: 32892699 DOI: 10.2989/16085906.2020.1790398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective: We compared the prevalence of frailty by HIV serostatus and related biomarkers to the modified frailty phenotype among older individuals in a rural population in South Africa. Methods: Questionnaire data were from a cohort of people living with HIV (PWH) on antiretroviral therapy (ART) and HIV-uninfected people aged 50 years and older sampled from the Africa Health Research Institute Demographic Health and Surveillance area in northern KwaZulu-Natal. The prevalence of frailty was compared using five categories: (1) physical activity; (2) mobility; (3) fatigue; (4) gait speed; and (5) grip strength, and assessed for demographic, clinical, and inflammatory correlates of frailty. Results: Among 614 individuals in the study, 384 (62.5%) were women. The median age at study enrolment was 64 years [Interquartile range (IQR) (58.6-72.0)]. 292 (47.6%) were PWH. 499 (81%) were classified as either pre-frail or frail. 43 (7%) were frail and HIV positive, 185 (30%) were pre-frail and HIV positive, 57 were frail and HIV negative and 214 (35%) were pre-frail and HIV negative. Frailty was similar for HIV negative and PWH (17.7% vs 14.7%, p = 0.72). Women were more likely to be frail (18.3% vs 13.04%, p = 0.16). The prevalence of frailty increased with age for both HIV groups. In the multivariable analysis, the odds of being frail were higher in those aged 70 years and above than those aged between 50 and 59 years (p < 0.001). Females were less likely to be pre-frail than males (p < 0.001). There was no association between any of the inflammatory biomarkers and frailty and pre-frailty. Conclusion: In this population, the prevalence of frailty is similar for PWH and people without HIV, but higher for women than men. These data suggest that the odds of developing frailty is similar for PWH over the age of 50 years, who survive into older age, as for people without HIV.
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Affiliation(s)
- Anita Edwards
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Harvard Medical School, Boston, USA
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Neuman
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Theresa Smit
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Paul Kowal
- World Health Organization, Division of Data, Analytics and Delivery for Impact, Geneva, Switzerland
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,London School of Hygiene and Tropical Medicine, London, UK
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McMillan JM, Gill MJ, Power C, Fujiwara E, Hogan DB, Rubin LH. Comorbidities in Older Persons with Controlled HIV Infection: Correlations with Frailty Index Subtypes. AIDS Patient Care STDS 2020; 34:284-294. [PMID: 32639207 DOI: 10.1089/apc.2020.0051] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Frailty is prevalent in persons with human immunodeficiency virus (PWH), but factors predisposing older PWH to frailty remain uncertain. We examined factors associated with frailty and determined whether there were multiple frailty subtypes in older adults with controlled HIV infection. This was a cross-sectional outpatient study in an urban HIV clinic. Twenty-nine clinical indicators were extracted from medical records to compute a Frailty Index (FI) for 389 older (age 50+) PWH (range = 50-93; mean = 61.1, standard deviation = 7.2; 85% men) receiving HIV treatment in Calgary, Canada. We used regressions to identify factors associated with FI values. Latent class analysis was used to identify FI subtypes. Age, employment status, and duration of known HIV infection were the strongest predictors of FI (p's < 0.05). Four FI subtypes were identified. Subtype 1 (severe metabolic dysfunction+polypharmacy) had the highest mean FI (0.30). Subtype 2 (less severe metabolic dysfunction+polypharmacy) and Subtype 3 (lung and liver dysfunction+polypharmacy) had lower but equivalent mean FIs (0.20 for each). Subtype 4 (least severe metabolic dysfunction) had the lowest mean FI (0.13; p's < 0.001). Sociodemographic and behavioral characteristics differed among the subtypes. Individuals with Subtype 1 were older and more frequently unemployed/retired, whereas those with Subtype 3 were more likely to smoke, use crack/cocaine, have heavy alcohol use, and live in temporary/unstable housing. The clinical presentation of frailty in older PWH is heterogeneous. The metabolic syndrome, hepatitis C virus coinfection, cirrhosis, lung disease, and polypharmacy were associated with frailty as were unemployment/retirement, unstable housing, and substance use.
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Affiliation(s)
- Jacqueline M. McMillan
- Section of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Canada
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael John Gill
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Christopher Power
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Esther Fujiwara
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - David B. Hogan
- Section of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Leah H. Rubin
- Department of Neurology and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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McMillan JM, Krentz HB, Gill MJ, Hogan DB. An Emerging Concern-High Rates of Frailty among Middle-aged and Older Individuals Living with HIV. Can Geriatr J 2019; 22:190-198. [PMID: 31885759 PMCID: PMC6887139 DOI: 10.5770/cgj.22.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background The aim of the present study was to calculate a frailty index (FI) in older adults (≥50) living with HIV, search for cross-sectional associations with the FI, and investigate the association between the FI score and two-year mortality. Methods Cross-sectional study with a short-term prospective component for the determination of two-year mortality was performed. The study took place in an HIV outpatient clinic in Calgary, Canada between November 1, 2016 and December 31, 2018. Over 700 patients 50 years of age or older took part. We calculated a FI for each patient, examined associations between FI and select patient characteristics, and evaluated the association between FI value and two-year mortality. Results The mean FI was 0.303 (± 0.128). Mean FI did not differ between males and females, nor was it associated with either nadir or current CD4 cell count. It did increase with age, duration of ART, and duration of diagnosed HIV infection. Mean FI was higher among those who died compared to survivors (0.351 vs. 0.301; p=.033). Conclusions Frailty is highly prevalent in persons living with HIV and associated with a higher mortality rate. Health-care providers should be aware of the earlier occurrence of frailty in adults living with HIV.
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Affiliation(s)
- Jacqueline M McMillan
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Southern Alberta Clinic, Calgary, AB, Canada
| | - Hartmut B Krentz
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Southern Alberta Clinic, Calgary, AB, Canada
| | - M John Gill
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Southern Alberta Clinic, Calgary, AB, Canada
| | - David B Hogan
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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26
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Blanco JR, Romero L, Ramalle-Gómara E, Metola L, Ibarra V, Sanz M, Oteo JA, Garcia A, Pérez-Martínez L. Retinol-binding protein 4 (RBP4), a potential biomarker of frailty in HIV-infected people on stable antiretroviral therapy. HIV Med 2019; 21:358-364. [PMID: 31885153 DOI: 10.1111/hiv.12837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A quantitative biomarker for identification of pre-frail and frail persons is still lacking. This study aimed to identify biomarker predictors of frailty in HIV-infected patients. METHODS A cross-sectional study of HIV-infected patients who had been on antiretroviral therapy (ART) for at least 1 year and who presented an undetectable viral load (< 50 HIV-1 RNA copies/mL) at baseline was carried out. For each frail patient, up to four pre-frail and robust patients were randomly selected. The frailty status assessment was based on the five-item criteria described by Fried et al. Sociodemographic, anthropometric, biochemical and HIV-related characteristics were evaluated. Multiple potential biomarkers of frailty and a biological age biomarker were analysed. RESULTS A total of 73 HIV-infected patients on ART for at least 1 year were evaluated. The patients were categorized as robust (n = 33), pre-frail (n = 32) and frail (n = 8) using the Fried criteria. All patients were on ART, with 100% undetectable viral load (< 50 copies/mL) at baseline. No significant differences in demographic, clinical or analytical characteristics were observed among patients in the different categories based on Fried criteria, with the exception of the veterans aging cohort study index (VACS). Similarly, no differences were observed in HIV-related characteristics, although nucleoside reverse transcriptase inhibitor (NRTI) use was less common in frail persons. The distribution of biomarker values varied according to frailty status, with frail persons having higher levels of interleukin (IL)-8, IL-18, CXC chemokine ligand 10 (CXCL10) and retinol-binding protein 4 (RBP4). In multivariable analysis, the assocation of frailty with RBP4 showed a tendency to statistical significance (odds ratio 1.0; 95% confidence interval 0.99-1.00; P < 0.05). CONCLUSIONS Differential biomarker expression was present according to Fried status. Longitudinal studies will clarify the utility of these biomarkers as targets for diagnostic or therapeutic intervention.
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Affiliation(s)
- J-R Blanco
- Biomedical Research Center of La Rioja (CIBIR), Department of Infectious Diseases, San Pedro University Hospital, Logroño, Spain.,Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain
| | - L Romero
- Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain
| | - E Ramalle-Gómara
- Department of Health of the Community of La Rioja, Government of La Rioja, Logroño, Spain
| | - L Metola
- Biomedical Research Center of La Rioja (CIBIR), Department of Infectious Diseases, San Pedro University Hospital, Logroño, Spain
| | - V Ibarra
- Biomedical Research Center of La Rioja (CIBIR), Department of Infectious Diseases, San Pedro University Hospital, Logroño, Spain
| | - M Sanz
- Biomedical Research Center of La Rioja (CIBIR), Department of Infectious Diseases, San Pedro University Hospital, Logroño, Spain
| | - J-A Oteo
- Biomedical Research Center of La Rioja (CIBIR), Department of Infectious Diseases, San Pedro University Hospital, Logroño, Spain.,Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain
| | - A Garcia
- Department of Infectious Diseases, San Pedro University Hospital, Logroño, Spain.,Department of Biomedical Diagnosis, San Pedro University Hospital, Logroño, Spain
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27
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Lwanga I, Nabaggala MS, Kiragga A, Calcagno A, Guaraldi G, Lamorde M, Castelnuovo B. Implementing routine physical function screening among elderly HIV-positive patients in Uganda. AIDS Care 2019; 32:1467-1470. [PMID: 31847531 DOI: 10.1080/09540121.2019.1703888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We conducted a cross-sectional study to describe routine physical function assessment for HIV-infected adults aged ≥60 years attending a large urban HIV clinic in Kampala, Uganda. Assessed demographic and clinical factors associated with low physical function in the population, generalized linear regression model was used to estimate factors associated with low physical function. Of the 93 elderly patients that underwent the Short Physical Performance Battery (SPPB) assessment, 43/93 (44.1%) scored 1-8 points at the SPPB evaluation and were categorized as low function, 45/93 (48.4%) scored 9-11 points and were categorized as moderate function and 7/93 (7.5%) scored 12 points and were categorized as high (normal) function. Women (adjusted risk ratio (ARR) 2.57; 95% confidence interval (CI): 1.54-4.29, p = 0.000) had increased risk of low physical function compared to men. A one-year increase in age (ARR = 1.09; CI: 1.03-1.15, p = 0.004) and being overweight (BMI > 25.0, ARR = 1.96; CI: 1.89-3.24, p = 0.008) also carried an increased risk of low physical function status. A higher number 13/41(32%) of falls was recorded in female than among male 3/53(5.8%) patients (p = 0.001). The SPPB assessment is a starting point for clinicians to comprehensively evaluate and consider the management of physical function limitation among older HIV-positive patients.
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Affiliation(s)
- Isaac Lwanga
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
| | | | - Agnes Kiragga
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
| | - Andrea Calcagno
- Department of Medical Sciences, Unit of Infectious Diseases, University of Torino, Torino, Italy
| | - Giovanni Guaraldi
- Infectious Diseases Unit, The University of Modena and Reggio Emilia, Modena, Italy
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
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28
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Prynn JE, Dube A, Mwaiyeghele E, Mwiba O, Geis S, Koole O, Nyirenda M, Kuper H, Crampin AC. Self-reported disability in rural Malawi: prevalence, incidence, and relationship to chronic conditions. Wellcome Open Res 2019; 4:90. [DOI: 10.12688/wellcomeopenres.15196.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in the low-income setting of Malawi. Methods: This study is nested in the Karonga Health and Demographic Surveillance Site in Malawi; the Washington Group questions were added to the annual survey in 2014. We used cross-sectional data from the 2014 survey to estimate the current prevalence of disability and examine associations of disability with certain chronic conditions. We then reviewed the consistency of responses to the questions over time using data from the 2015 survey. Results: Of 10,863 participants, 9.6% (95% CI 9.0-10.1%) reported disability in at least one domain. Prevalence was higher among women and increased with age. Obesity and diabetes were associated with disability, but hypertension and HIV were not. Participants reporting “no difficulty” or “can’t do at all” for any domain were likely to report the same status one year later, whereas there was considerable movement between people describing “some difficulty” and “a lot of difficulty”. Conclusions: Disability prevalence is high and likely to increase over time. Further research into the situation of this population is crucial to ensure inclusive policies are created and sustainable development goals are met.
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Yeoh HL, Cheng A, Palmer C, Crowe SM, Hoy JF. Frailty in men living with HIV: a cross-sectional comparison of three frailty instruments. Antivir Ther 2019; 23:117-127. [PMID: 28731422 DOI: 10.3851/imp3185] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Potent antiretroviral treatment has resulted in near normal life expectancy for people living with HIV. Consequently, there is an increased focus on comorbidities, frailty and quality of life. METHODS We assessed and compared the prevalence of frailty, associated factors and relationship with quality of life in older Australian men living with HIV in a cross-sectional study using three frailty measurements. The Frailty Phenotype, Frailty Index and Edmonton Frail Scale were applied to 93 HIV-infected men aged over 50 years, on antiretroviral therapy. Multivariable ordinal logistic regression was used to analyse the associations of frailty with covariates and quality of life. RESULTS The prevalence of frailty was 10.8% (n=10) using the Frailty Phenotype; 22.6% (n=21) using the Frailty Index and 15.1% (n=14) using the Edmonton Frail Scale. Frailty Phenotype-defined pre-frailty/frailty was associated with pre-1996 ART initiation (OR, 3.56; CI, 1.23, 10.36; P=0.020) and depression (OR, 3.74; CI, 1.24, 11.27; P=0.019). Osteoporosis, serious non-AIDS events and AIDS were associated with Frailty Index-defined frailty (OR, 4.84, CI, 1.27, 18.43, P=0.021; OR, 4.27, CI, 1.25, 14.58, P=0.020; OR, 4.62, CI, 1.30, 16.45, P=0.018, respectively) and Edmonton Frail Scale-defined frailty (OR, 7.51; CI, 1.55, 36.42; P=0.012; OR, 7.71; CI, 1.62, 36.75; P=0.010; OR, 8.53; CI, 1.70, 42.73; P=0.009, respectively), independent of age and current CD4+ T-cell count. Frailty, defined by any of the instruments, was significantly associated with poorer quality of life (P<0.001). CONCLUSIONS Identifying frailty is an increasingly important contemporary consideration of HIV care related to ageing and quality of life.
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Affiliation(s)
- Hui-Ling Yeoh
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Allen Cheng
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Clovis Palmer
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Suzanne M Crowe
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Jennifer F Hoy
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia
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Zeballos D, Lins L, Brites C. Frailty and Its Association with Health Related Quality of Life in Older HIV Patients, in Salvador, Brazil. AIDS Res Hum Retroviruses 2019; 35:1074-1081. [PMID: 31373215 DOI: 10.1089/aid.2019.0103] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Frailty is a geriatric syndrome that may develop earlier in the presence of HIV. Frail individuals are more vulnerable to adverse health outcomes and poorer quality of life. This study aimed to determine the prevalence and factors associated with frailty and to define the impact of frailty on quality of life. A cross-sectional study was conducted with 201 adults living with HIV, aged 50 or older, receiving outpatient care between April and November of 2017 at a referral center in Salvador, Brazil. Frailty was assessed using Fried frailty phenotype. Factors related to frailty were identified using multinomial logistic regression. The association between frailty and quality of life was tested through multiple linear regression. All but one patient were on antiretroviral therapy. The median age was 55 years (range 50-83 years), 63.7% were males, and 91.6% self-identified as black or racially mixed. The median CD4 cell count was 673 cells/mm3 (IQR 470-900), and 88.1% were virally suppressed. The prevalence of frailty and prefrailty was 19.4% and 49.3%, respectively. Female sex, unemployment, and pain were associated with frailty. Unemployment and the use of nucleoside reverse transcriptase inhibitors were associated with prefrailty. Frailty was associated with a decrease in health-related quality of life. The prevalence of frailty was higher than the prevalence found in general population which was at least 10 years older. Half of the participants were prefrail, indicating the need for improved long-term care. Pain management is a potential target for interventions to prevent frailty and to improve quality of life.
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Affiliation(s)
- Diana Zeballos
- Post-graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Liliane Lins
- Post-graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
- LAPI - Research Laboratory of Infectious Diseases, University Hospital Professor Edgard Santos, School of Medicine, Salvador, Brazil
| | - Carlos Brites
- Post-graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
- LAPI - Research Laboratory of Infectious Diseases, University Hospital Professor Edgard Santos, School of Medicine, Salvador, Brazil
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Naidoo K, van Wyk J. Protocol for a scoping review of age-related health conditions among geriatric populations in sub-Saharan Africa. Syst Rev 2019; 8:133. [PMID: 31174593 PMCID: PMC6554952 DOI: 10.1186/s13643-019-1055-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/26/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Keshena Naidoo
- Discipline of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Jacqueline van Wyk
- Discipline of Clinical and Professional practice, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Abstract
PURPOSE OF REVIEW As a consequence of antiretroviral therapy, the proportion of older HIV-infected adults is increasing, with a concomitant shift in burden of illness to age-related syndromes and disease. Frailty is an age-related syndrome of increased vulnerability to stress, predictive of major adverse clinical outcomes among HIV-infected and uninfected persons alike. Understanding frailty pathogenesis is critical to developing interventions to improve health outcomes in HIV. Here, we review the current evidence for the relationship between inflammation and frailty in HIV, and the potential for novel, inflammation-targeted interventions. RECENT FINDINGS Dysregulated inflammation has been consistently associated with frailty in elderly HIV-uninfected persons. Dysregulated inflammation is also central to HIV pathophysiology and several recent studies have demonstrated the important association of inflammation with frailty in HIV. Some evidence suggests that anti-inflammatory therapies may be effective in ameliorating the adverse impact of frailty among aging HIV-infected adults, though further investigation is necessary. Inflammation has been implicated in frailty in HIV infection, and improved understanding of the role that inflammation plays in frailty pathogenesis is key to the development of effective therapies to slow or prevent frailty in the vulnerable HIV-infected population.
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Wu C. Commentary: Impact of new hypertension guideline among people living with HIV in Ghana. J Clin Hypertens (Greenwich) 2019; 21:851-852. [PMID: 31125178 DOI: 10.1111/jch.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Duke Global Health Institute, Duke University, Durham, North Carolina
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34
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Gender differences for frailty in HIV-infected patients on stable antiretroviral therapy and with an undetectable viral load. PLoS One 2019; 14:e0215764. [PMID: 31071105 PMCID: PMC6508723 DOI: 10.1371/journal.pone.0215764] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/08/2019] [Indexed: 12/16/2022] Open
Abstract
Background Patients with HIV infection suffer from accelerated aging. In this context, frailty could be a relevant problem that aggravates the quality of life (QoL) and morbi-mortality of these patients. Our objective was to determine the prevalence of frailty and pre-frailty in HIV-infected patients in our cohort as well as their risk factors and QoL. Methods This was a prospective cross-sectional study of HIV-infected people aged ≥18 years on a stable antiretroviral regimen (ART) ≥1 year. Frailty was defined by ≥3 of 5 Fried's criteria: weight loss, low physical activity, exhaustion, weak grip strength and slow walking time. Variables related to sociodemographics, HIV infection, comorbidities, polypharmacy, and QoL were evaluated. Independent predictors of frailty were evaluated using collinearity in a multivariate logistic regression analyses (backward stepwise elimination). Results The 248 people studied has a mean age of 49 years, 63.7% were male, and 81% were Caucasian. The prevalence of pre-frailty and fragility was 39.1% and 4.4%, respectively. The main route of HIV acquisition was heterosexual (47.2%). At the inclusion time 26.6% of the patients had AIDS events, 60.9% were anti-HCV negative, and 91.5% had HIV RNA <50 copies/mL (84.3% for ≥1 year); 10.9% had >2 comorbidities, and 13.3% were receiving >5 non-HIV drugs. Frailty patients had a higher age (p 0.006), more sensitive deficits (visual or auditory) (p 0.002), a greater number of falls during the previous year (p 0.0001), a higher Charlson comorbidity index (p 0.001), and a higher VACS index (p 0.001). All comorbidities, excluding bone and liver, were significantly more frequent in fragile patients. The presence of >2 comorbidities and treatment with >5 drugs not related to HIV they were also more frequent in frail patienst (p 0.0001 and p 0.004, respectively). Independent predictors of pre-frailty/frailty in the multivariable analysis differ in men (VACS index, C-reactive protein [CRP], and falls) and women (CRP, AIDS, and menopause). Patients with pre-frailty/frailty had some indicator of a lower QoL. Conclusion Factors associated with pre-frailty/frailty in HIV-infected patients differ by gender, which should be considered when establishing measures for prevention. The role of menopause in the risk of pre-frailty/frailty warrants further investigations.
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Torgersen J, Bellamy SL, Ratshaa B, Han X, Mosepele M, Zuppa AF, Vujkovic M, Steenhoff A, Bisson GP, Gross R. Impact of Efavirenz Metabolism on Loss to Care in Older HIV+ Africans. Eur J Drug Metab Pharmacokinet 2019; 44:179-187. [PMID: 30168000 PMCID: PMC6420397 DOI: 10.1007/s13318-018-0507-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE: Efavirenz is commonly used in Africa and is frequently associated with neurocognitive toxicity, which may compromise clinical outcomes. Older individuals are at increased risk for drug toxicity and clinical outcomes may be worse in older age, particularly among those individuals with cytochrome P450 (CYP) 2B6 polymorphisms associated with slower efavirenz metabolism. The aim of this study was to determine if the CYP2B6 polymorphisms differentially impacts loss to care in older people. METHODS We conducted a prospective cohort study of 914 treatment-naïve HIV+ adults initiating efavirenz-based antiretroviral treatment at public HIV clinics in Gaborone, Botswana between 2009 and 2013. Older age, defined as age ≥ 50 years, was the primary exposure and loss to care at 6 months was the primary outcome. Interaction between age and CYP2B6 516G>T and 983T>C polymorphisms, defined as extensive, intermediate, and slow metabolism, was assessed. Neurocognitive toxicity was measured using a symptom questionnaire. Age-stratified logistic regression was performed to identify factors associated with loss to care. RESULTS Older age was associated with loss to care (OR 1.95, 95% CI 1.30-2.92). Age modified the effect of CYP2B6 genotype on loss to care with older, slow metabolizers at over four-fold higher risk when compared to older, intermediate metabolizers (OR 4.06 95% CI 1.38-11.89); neurocognitive toxicity did not mediate this risk. CYP2B6 metabolism genotype did not increase risk of loss to care in younger participants. CONCLUSION Older age was associated with loss to care, especially among those with slow efavirenz metabolism. Understanding the relationship between older age and CYP2B6 genotype will be important to improving outcomes in an aging population initiating efavirenz-based ART in similar settings.
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Affiliation(s)
- Jessie Torgersen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Scarlett L. Bellamy
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | | | - Xiaoyan Han
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Athena F Zuppa
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marijana Vujkovic
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew Steenhoff
- Botswana UPenn Partnership, Gaborone, Botswana
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory P. Bisson
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gross
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Guaraldi G, Zona S, Silva AR, Menozzi M, Dolci G, Milic J, Carli F, Mussini C. The dynamic association between Frailty, CD4 and CD4/CD8 ratio in people aging with HIV. PLoS One 2019; 14:e0212283. [PMID: 30763363 PMCID: PMC6375603 DOI: 10.1371/journal.pone.0212283] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/30/2019] [Indexed: 01/02/2023] Open
Abstract
Objective To investigate the association between current CD4+ T-cell count and CD4/CD8+ ratio with severity of frailty among people aging with HIV. Methods Cross-sectional observational study analysing data from all study visits in the ongoing prospective Modena HIV Metabolic Clinic Cohort between 2006 and 2015. Frailty severity was assessed using a frailty index (FI). We visualized the relationships between frailty index score and current CD4 cell count and CD4/CD8 ratio on two different curves adjusted for age, sex, and duration of HIV infection. Results Frailty index scores exhibited an inverse relationship with current CD4 count, up to 900 cells/μL. The CD4/CD8 ratio was inversely correlated with frailty index both below and above the cut-off of 900 CD4 cells/μL. Conclusions Frailty in PLWH is inversely associated with both immune-activation, depicted by CD4/CD8 ratio and immune-deficit depicted by CD4 count. The first association shows a linear shape while the second shows a hook-shape with a turning point at 900 cells. Above this cut off level CD4 do not represent a significant risk factor for frailty.
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Affiliation(s)
- Giovanni Guaraldi
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
- * E-mail:
| | - Stefano Zona
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Ana Rita Silva
- Department of Infectious Diseases, Hospital Beatriz Ângelo, Loures, Portugal
| | - Marianna Menozzi
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Dolci
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Carli
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
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Abstract
: Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the central nervous system (CNS) may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Although there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain. In many resource-limited settings, antiretrovirals considered second or third line in the United States, which carry substantial neurotoxicity, remain mainstays of treatment, and patients continue to present with severe immunosuppression and CNS opportunistic infections. Despite this, increased global access to cART has coincided with an aging HIV-positive population with cognitive sequelae, cerebrovascular disease, and peripheral neuropathy. Further neurological research in low-income and middle-income countries (LMICs) is needed to address the burden of neurological complications in HIV-positive patients, particularly regarding CNS viral reservoirs and their effects on eradication.
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Jiménez Z, Sánchez-Conde M, Brañas F. [HIV infection as a cause of accelerated aging and frailty]. Rev Esp Geriatr Gerontol 2019; 53:105-110. [PMID: 28601217 DOI: 10.1016/j.regg.2017.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/04/2017] [Indexed: 12/21/2022]
Abstract
The HIV-infected population is aging due to the success of combination antiretroviral therapy, which prolongs survival, as well as the growing number of newly diagnosed cases in adults 50 years old and over. HIV-infected individuals suffer from an accelerated aging due to the persistent and chronic activation of the immune system that leads to immune exhaustion and accelerated immunosenescence, even when on optimal immuno-virological control treatment. The clinical expression of the immunosenescence state is an increased prevalence of aging-related non-HIV associated comorbidities and a rising prevalence of frailty occurring earlier than in the general population. Thus, HIV-infected patients are biologically older than their chronological age, and they suffer from aging-related problems, such as frailty, which should be assessed.
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Affiliation(s)
- Zaida Jiménez
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, España
| | - Matilde Sánchez-Conde
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Fátima Brañas
- Unidad de Geriatría, Hospital Universitario Infanta Leonor, Madrid, España.
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Wulunggono W, Yunihastuti E, Shatri H, Wahyudi ER, Ophinni Y. Frailty among HIV-1 Infected Adults under Antiretroviral Therapy in Indonesia. Curr HIV Res 2019; 17:204-213. [PMID: 31456523 PMCID: PMC7061977 DOI: 10.2174/1570162x17666190828143947] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Increasing age of HIV-1 infected population brought about the risk of frailty as comorbidity, whose prevalence is higher in low and middle-income countries (LMICs). Indonesia as an LMIC also bears a major burden of HIV-1 epidemic with a similarly aging population, but the prevalence of frailty and its predictors are unknown. OBJECTIVES To identify the prevalence of frailty and analyze its associated factors, among HIV-1 infected adults under antiretroviral therapy in Indonesia. METHODS A cross-sectional study was conducted among HIV-infected individuals with inclusion criteria of age ≥30 years old and underwent ART for at least 6 months. The main assessment was done using Fried's frailty phenotype score, which categorizes subjects into non-frail, pre-frail, or frail. Factors associated with frailty were characterized and multiple logistic regression analysis was performed. RESULTS A total of 164 subjects were recruited; male subjects were 118 (72%), the median age was 40.5 years old, and the median CD4 nadir was 53 cells/μl. Frailty was identified among 90 (54.9%) subjects with 84 (51.2%) identified as pre-frail and 6 (3.7%) as frail, with dominant frailty phenotype was weakness in grip strength. The multivariate model showed that depression was the only factor significantly correlated with pre-frailty and frailty (OR 2.14; 95% CI 1.04-4.43, p=0.036). CONCLUSION Frailty is a common occurrence among HIV-infected patients under ART, with depression as an independent predictive factor.
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Affiliation(s)
- Wulunggono Wulunggono
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Evy Yunihastuti
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Hamzah Shatri
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Edy Rizal Wahyudi
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Youdiil Ophinni
- Department of Pathology, Graduate School of Medicine, Kobe University, Kobe, Japan
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Butler I, MacLeod W, Majuba PP, Tipping B. Human immunodeficiency virus infection and older adults: A retrospective single-site cohort study from Johannesburg, South Africa. South Afr J HIV Med 2018; 19:838. [PMID: 30568838 PMCID: PMC6295827 DOI: 10.4102/sajhivmed.v19i1.838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 06/08/2018] [Indexed: 11/01/2022] Open
Abstract
Introduction HIV-infected adults aged over 50 years in South Africa are increasing. This study explored differences between baseline characteristics and 12-month outcomes of younger and older HIV-infected adults initiated on antiretroviral therapy (ART). Additionally, associations with outcomes within the older group were sought. Methods We retrospectively reviewed treatment-naive HIV-infected adult patients at ART initiation. Patients aged 18.0-39.9 years were compared to patients aged over 50 years using log-binomial regression for baseline characteristics and 12-month outcomes. Within the older group, outcome associations were found using multivariate regression. Results The older cohort (n = 1635) compared to the younger cohort (n = 10726) comprised more males (47.2% vs. 35.4%, PR 1.52, p < 0.05), smokers (12.9% vs. 9.7%, PR 1.32, p < 0.05) and overweight patients (26.0% vs. 20.0%, PR 1.32, p < 0.05). Fewer older patients had tuberculosis (10.2% vs. 15.3%, PR 0.67, p < 0.05), other opportunistic infections (16.9% vs. 23.3%, PR 0.70, p < 0.05), World Health Organization stage 3/4 disease (39.9% vs. 43.2%, PR 0.89, p < 0.05), anaemia (22.8% vs. 28.4%, PR 0.77, p < 0.05), liver dysfunction (17.1% vs. 21.3%, PR 0.83, p < 0.05) or low CD4+ count < 100 cells/mm3 (56.3% vs. 59.9%, PR 0.71, p < 0.05).Mortality was higher in the older cohort (11.3% vs. 7.5%, PR 1.48, p < 0.05). Virological suppression was greater in the older cohort (89.5% vs. 86.5%, PR 1.28, p < 0.05) but CD4+ restitution was lower (62.8% vs. 75.0%, PR 0.61, p < 0.05). There was no difference in treatment complications between the groups.Within the older cohort, associations with death were as follows: age > 55 years (PR 1.47, p < 0.05), an AIDS-defining condition (PR 2.28, p < 0.05), raised ALT (PR 1.53, p < 0.05) and CD4+ < 100 cells/mm3 (PR 2.15, p < 0.05). Associations with favourable treatment response at 12 months were unemployment (PR 1.18, p < 0.05) and raised ALT (PR 1.19, p < 0.05). Associations with a treatment complication at 12 months were unemployment (PR 1.12, p < 0.05), smoking (PR 1.20, p < 0.05) and nevirapine use (PR 1.36, p < 0.05) but secondary education was protective (PR 0.87, p < 0.05). Conclusion HIV-infected South African adults aged over 50 years differ in characteristics and outcomes compared to their younger counterparts and justify specialised management within HIV treatment facilities.
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Affiliation(s)
- India Butler
- Division of Geriatric Medicine, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - William MacLeod
- Health Economics and Epidemiology Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | | | - Brent Tipping
- Division of Geriatric Medicine, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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Geriatric-HIV Medicine: the geriatrician’s role. Eur Geriatr Med 2018; 10:259-265. [DOI: 10.1007/s41999-018-0144-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/24/2018] [Indexed: 12/21/2022]
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Abstract
OBJECTIVE Sedentary behaviour (SB) is harmful for health and well-being and may be associated with depression. However, little is known about the correlates of SB in people with depression. Thus, we investigated SB correlates among community-dwelling adults with depression in six low- and middle-income countries. METHODS Cross-sectional data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. The analysis was restricted to those with DSM-IV Depression or receiving depression treatment in the last 12 months. Self-reported time spent sedentary per day was the outcome. High SB was defined as ≥8 hours of SB per day. The correlates (sociodemographic and health-related) of SB were estimated by multivariable linear and logistic regression analyses. RESULTS In 2375 individuals with depression (mean age=48.0 years; 60.7% female), the prevalence of high SB was 11.1% (95%CI=8.2%-14.9%), while the mean (±SD) time spent sedentary was 215 (±192) minutes per day. Socio-demographic factors significantly associated with high SB were older age and being unmarried, being male and being unemployed. In other domains, no alcohol consumption, current smoking, mild cognitive impairment, bodily pain, arthritis, stroke, disability, and lower levels of social cohesion, COPD, visual impairment, and poor self-rated health was associated with greater time spent sedentary. CONCLUSION Our data suggest that future interventions seeking to reduce SB among individuals with depression may target at risk groups based on identified sociodemographic correlates while the promotion of social cohesion may have the potential to increase the efficacy of future public health initiatives. From a clinical perspective, bodily pain and somatic co-morbidities need to be taken into account.
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Abdominal obesity, sarcopenia, and osteoporosis are associated with frailty in men living with and without HIV. AIDS 2018; 32:1257-1266. [PMID: 29794494 DOI: 10.1097/qad.0000000000001829] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The relationships between frailty and body composition in older adults with HIV infection are poorly understood. We sought to describe associations between frailty and measures of body composition among adult men with HIV and without HIV. DESIGN/METHODS Men with and without HIV (age 50-69 years) in the Multicenter AIDS Cohort Study (MACS) Bone Strength Substudy were included if evaluated for frailty (by Fried phenotype) and body composition [BMI, waist circumference, abdominal visceral (VAT) and subcutaneous (SAT) adipose tissue, sarcopenia, and osteopenia/osteoporosis]. All participants with HIV infection were on antiretroviral therapy. Multivariate multinomial logistic regression models were used to determine associations of frailty with body composition. RESULTS A total of 399 men, including 199 men with HIV and 200 men without HIV, both with median age 60 years, constituted our study population. Frailty prevalence was 16% (men with HIV) vs. 8% (men without HIV). HIV serostatus was associated with a 2.43 times higher odds of frailty (P = 0.01). Higher waist circumference, VAT, sarcopenia, and femoral neck osteoporosis were associated with increased odds of frailty (aOR 4.18, 4.45, 4.15, and 13.6, respectively, and all P < 0.05); BMI and SAT were not. None of these measures presented a differential association with frailty by HIV serostatus (all P > 0.20). CONCLUSION Higher abdominal obesity and sarcopenia were associated with frailty among men with and without HIV. Assessment of these body composition parameters may help detect frailty in the clinical setting.
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Lewis EG, Wood G, Howorth K, Shah B, Mulligan L, Kissima J, Dotchin C, Gray W, Urasa S, Walker R. Prevalence of Frailty in Older Community-Dwelling Tanzanians According to Comprehensive Geriatric Assessment. J Am Geriatr Soc 2018; 66:1484-1490. [DOI: 10.1111/jgs.15433] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Emma G. Lewis
- Institute of Health and Society, Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - Greta Wood
- Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
| | - Kate Howorth
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - Bhavini Shah
- West Middlesex University Hospital; Chelsea and Westminster Hospital National Health Service Foundation Trust; Middlesex United Kingdom
| | - Louise Mulligan
- Fiona Stanley Hospital; South Metropolitan Health Service; Murdoch Western Australia Australia
| | - John Kissima
- Hai District Hospital, Boma Ng'ombe, Hai; Kilimanjaro Tanzania
| | - Catherine Dotchin
- Institute of Health and Society, Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - William Gray
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi; Kilimanjaro Tanzania
| | - Richard Walker
- Institute of Health and Society, Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
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Vancampfort D, Stubbs B, Mugisha J. Physical activity and HIV in sub-Saharan Africa: a systematic review of correlates and levels. Afr Health Sci 2018; 18:394-406. [PMID: 30602967 PMCID: PMC6306981 DOI: 10.4314/ahs.v18i2.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Self-management strategies such as physical activity (PA) can address disability and optimize mental, physical, social and economic outcomes for persons living with HIV (PLWH). Understanding factors that influence PA behavior in PLWH is a first step in order to devise effective interventions. Objective The present review provides a systematic review of the correlates of PA in PLWH in sub-Saharan Africa. Methods Electronic databases were searched till April 2016. Keywords included ‘physical activity’ or ‘exercise’ or ‘sports’ and ‘AIDS’ or ‘HIV’. Results Ten correlates were identified in 6 studies including 1,015 (329♂) PLWH (mean age range=30.5–40.8years). Lower levels of PA were associated with older age (2/2 studies), a lower number of CD4 cells/µl (1/1), a more severe HIV-stage (1/1), a higher HIV load (1/1), the presence of opportunistic infections (1/1) and a higher BMI (1/1). Fisher's exact tests showed there were more significant correlates in objective tools versus subjective self-report (P=0.03). Conclusion The current review shows that participation in PA by PLWH in sub-Saharan Africa is associated with a range of complex factors which should be considered in the daily care of PLWH. This however might require repackaging of the current interventions for PLWH to allow a focus on PA.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven — University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- KU Leuven — University of Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - James Mugisha
- Butabika National Referral and Mental Health Hospital, Kampala, Uganda
- Kyambogo University, Kampala, Uganda
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McGettrick P, Barco EA, Mallon PWG. Ageing with HIV. Healthcare (Basel) 2018; 6:healthcare6010017. [PMID: 29443936 PMCID: PMC5872224 DOI: 10.3390/healthcare6010017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/29/2018] [Accepted: 02/07/2018] [Indexed: 12/13/2022] Open
Abstract
The population of people living with HIV (PLWH) is growing older with an estimated 4 million over the age of 50 years, a figure which has doubled since the introduction of effective antiretroviral therapy (ART) and which is increasing globally. Despite effective ART, PLWH still experience excess morbidity and mortality compared to the general population with increased prevalence of age-related, non-AIDS illnesses (NAI) such as cardiovascular disease, malignancies, cognitive impairment and reduced bone mineral density, which impact disability and everyday functioning. This review will discuss the challenges presented by comorbidities in ageing PLWH and discuss the aetiology and management of age-related illnesses in this vulnerable population.
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Affiliation(s)
- Padraig McGettrick
- HIV Molecular Research Group, UCD School of Medicine, University College Dublin, Dublin, Ireland.
- Mater Misericordae University Hospital, Eccles street, Dublin 7, Ireland.
| | - Elena Alvarez Barco
- HIV Molecular Research Group, UCD School of Medicine, University College Dublin, Dublin, Ireland.
| | - Patrick W G Mallon
- HIV Molecular Research Group, UCD School of Medicine, University College Dublin, Dublin, Ireland.
- Mater Misericordae University Hospital, Eccles street, Dublin 7, Ireland.
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Petit N, Enel P, Ravaux I, Darque A, Baumstarck K, Bregigeon S, Retornaz F. Frail and pre-frail phenotype is associated with pain in older HIV-infected patients. Medicine (Baltimore) 2018; 97:e9852. [PMID: 29419697 PMCID: PMC5944687 DOI: 10.1097/md.0000000000009852] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
As HIV-infected patients grow older, some accumulate multiple health problems earlier than the noninfected ones in particular frailty phenotypes. Patients with frailty phenotype are at higher risk of adverse outcomes (worsening mobility, disability, hospitalization, and death within three years).Our study aimed to evaluate prevalence of frailty in elderly HIV-infected patients and to assess whether frailty is associated with HIV and geriatric factors, comorbidities, and precariousness in a French cohort of older HIV infected.This 18-month cross-sectional multicenter study carried in 2013 to 2014 had involved 502 HIV-infected patients aged 50 years and older, cared in 18 HIV-dedicated hospital medical units, located in South of France.Prevalence of frailty was 6.3% and of pre-frailty 57.2%. Low physical activity and weakness were the main frailty markers, respectively 49.4% and 19.9%. In univariate models, precariousness, duration of HIV antiretroviral treatment >15 years, 2 comorbidities or more, risk of depression, activities of daily living disability, and presence of pain were significantly associated with frail and pre-frail phenotype. Multivariate logistic regression analyses showed that only pain was significantly different between frail and pre frail phenotype versus non frail phenotype (odds ratio = 1.2; P = .002).Our study is the first showing a significant association between pain and frailty phenotype in older patients infected by HIV. As frailty phenotype could be potentially reversible, a better understanding of the underlying determinant is warranted. Further studies are needed to confirm these first findings.
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Affiliation(s)
- Nathalie Petit
- Department of Internal, Geriatric and Therapeutic Medicine, University Hospital Center AP-HM
| | - Patricia Enel
- HIV regional network COREVIH, University Hospital Center AP-HM
- Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University
| | - Isabelle Ravaux
- HIV regional network COREVIH, University Hospital Center AP-HM
- University Hospital Institute for Infectious and Tropical Diseases, IHU Méditerranée Infection
| | - Albert Darque
- HIV regional network COREVIH, University Hospital Center AP-HM
- Hospital Pharmacy, University Hospital Center AP-HM
| | - Karine Baumstarck
- Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University
| | - Sylvie Bregigeon
- Department of Clinical Immuno-Hematology, University Hospital Center AP-HM
| | - Frédérique Retornaz
- Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University
- Silvermed Institute and Division of Geriatric Medicine, State Geriatric Centre
- Department of Internal Medicine and Infectious Diseases, European Hospital, Marseille, France
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Wright EJ, Thakur KT, Bearden D, Birbeck GL. Global developments in HIV neurology. HANDBOOK OF CLINICAL NEUROLOGY 2018; 152:265-287. [PMID: 29604981 DOI: 10.1016/b978-0-444-63849-6.00019-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurologic conditions associated with HIV remain major contributors to morbidity and mortality, and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence suggests that the central nervous system (CNS) serves as a reservoir for viral replication with major implications for human immunodeficiency virus (HIV) eradication strategies. Though there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of HIV-associated neurologic conditions, significant scientific gaps remain. In many low-income settings, second- and third-line cART regimens that carry substantial neurotoxicity remain treatment mainstays. Further, patients continue to present severely immunosuppressed with CNS opportunistic infections. Public health efforts should emphasize improvements in access and optimizing treatment of HIV-positive patients, specifically in resource-limited settings, to reduce the risk of neurologic sequelae.
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Affiliation(s)
- Edwina J Wright
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Australia; The Burnet Institute, Melbourne, Australia; Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Kiran T Thakur
- Division of Critical Care and Hospitalist Neurology, Columbia University Medical Center, New York, NY, United States
| | - David Bearden
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Gretchen L Birbeck
- Strong Epilepsy Center, Department of Neurology, University of Rochester, Rochester, NY, United States; Chikankata Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia
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Vancampfort D, Stubbs B, Firth J, Hallgren M, Schuch F, Lahti J, Rosenbaum S, Ward PB, Mugisha J, Carvalho AF, Koyanagi A. Physical activity correlates among 24,230 people with depression across 46 low- and middle-income countries. J Affect Disord 2017. [PMID: 28633049 DOI: 10.1016/j.jad.2017.06.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a paucity of nationally representative data available on the correlates of physical activity (PA) among people with depression, especially in low- and middle-income countries (LMICs). Thus, we investigated PA correlates among community-dwelling adults with depression in this setting. METHODS World Health Survey data included 24,230 adults (43.1 ± 16.1 years; 36.1% male) with ICD-10 diagnoses of depression including brief depressive episode and subsyndromal depression aged ≥ 18 years from 46 LMICs. PA was assessed by the International Physical Activity Questionnaire. Participants were dichotomised into low and moderate-to-high physically active groups. Associations between PA and a range of sociodemographic, health behaviour and mental and physical health variables were examined using multivariable logistic regressions. RESULTS 34.8% of participants with depression were physically inactive. In the multivariate analyses, inactivity was associated with male sex, older age, not being married/cohabiting, high socio-economic status, unemployment, living in an urban setting, less vegetable consumption, and poor sleep/ low energy. In addition, mobility difficulties and some somatic co-morbidity were associated with not complying with the 150min per week moderate-to-vigorous PA recommendations. CONCLUSIONS The current data provide guidance for future population level interventions across LMICs to help people with depression engage in regular PA.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; University Psychiatric Centre KU Leuven, Kortenberg, Belgium.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, United Kingdom
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom; NICM, School of Science and Health, University of Western Sydney, Australia
| | - Mats Hallgren
- Department of Public Health Sciences, Karolinksa Institute, Stockholm, Sweden
| | - Felipe Schuch
- Unilasalle, Canoas, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Simon Rosenbaum
- Black Dog Institute, Randwick, Australia; School of Psychiatry, UNSW, Sydney, Australia
| | - Philip B Ward
- School of Psychiatry, UNSW, Sydney, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - James Mugisha
- Kyambogo University, Kampala, Uganda; Butabika National Referral and Mental Health Hospital, Kampala, Uganda
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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50
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Walston J, Robinson TN, Zieman S, Eldadah BA, McFarland F, Carpenter CR, Althoff KN, Andrew MK, Blaum CS, Brown PJ, Buta B, Ely EW, Ferrucci L, High KP, Kritchevsky SB, Rockwood K, Schmader KE, Sierra F, Sink KM, Varadhan R, Hurria A. Integrating Frailty Research into the Medical Specialties-Report from a U13 Conference. J Am Geriatr Soc 2017; 65:2134-2139. [PMID: 28422280 PMCID: PMC5641231 DOI: 10.1111/jgs.14902] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although the field of frailty research has expanded rapidly, it is still a nascent concept within the clinical specialties. Frailty, conceptualized as greater vulnerability to stressors because of significant depletion of physiological reserves, predicts poorer outcomes in several medical specialties, including cardiology, human immunodeficiency virus care, and nephrology, and in the behavioral and social sciences. Lack of a consensus definition, proliferation of measurement tools, inadequate understanding of the biology of frailty, and lack of validated clinical algorithms for frail individuals hinders incorporation of frailty assessment and frailty research into the specialties. In 2015, the American Geriatrics Society, the National Institute on Aging (NIA), and the Alliance for Academic Internal Medicine held a conference for awardees of the NIA-sponsored Grants for Early Medical/Surgical Specialists Transition into Aging Research program to review the current state of knowledge regarding frailty in the subspecialties and to highlight examples of integrating frailty research into the medical specialties. Research questions to advance frailty research into specialty medicine are proposed.
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Affiliation(s)
- Jeremy Walston
- Division of Geriatric Medicine and Frailty, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Susan Zieman
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging/National Institutes of Health, Bethesda, MD
| | - Basil A. Eldadah
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging/National Institutes of Health, Bethesda, MD
| | | | - Christopher R. Carpenter
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Keri N Althoff
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Melissa K. Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Caroline S. Blaum
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University, New York, NY
| | - Patrick J. Brown
- Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
- Program on Healthy Aging and Late Life Brain Disorders, Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY
| | - Brian Buta
- Center on Aging and Health, John Hopkins University, Baltimore, MD
| | - E. Wesley Ely
- Division of Pulmonary and Critical Care and Health Services Research, Vanderbilt University and VA Geriatric Research Education Clinical Center (GRECC), Nashville, TN
| | - Luigi Ferrucci
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging/National Institutes of Health, Bethesda, MD
| | | | - Stephen B. Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Kenneth E. Schmader
- Center for the Study of Aging, Duke University Medical Center, Durham, NC
- GRECC Durham VA Medical Center, Durham, NC
| | - Felipe Sierra
- Division of Aging Biology, National Institute on Aging, NIH, Bethesda, MD
| | - Kaycee M. Sink
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University, Baltimore, MD
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Department of Medical Oncology and Therapeutic Research, Duarte, CA
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