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Inceer M, Mayo N. Health-related quality of life measures provide information on the contributors, components, and consequences of frailty in HIV: a systematic mapping review. Qual Life Res 2024; 33:1735-1751. [PMID: 38462582 DOI: 10.1007/s11136-024-03613-3] [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] [Accepted: 01/23/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE Frailty in HIV is extensively explored in epidemiological and clinical studies; it is infrequently assessed as an outcome in routine care. The focus on health-related quality of life (HRQL) measures in HIV presents a unique opportunity to understand frailty at a larger scale. The objective was to identify the extent to which generic and HIV-related HRQL measures capture information relevant to frailty. METHODS A systematic mapping review using directed and summative content analyses was conducted. An online search in PubMed/Medline identified publications on frailty indices and generic and HIV-related HRQL measures. Directed content analysis involved identifying contributors, components, and consequences of frailty from the frailty indices based on the International Classification of Functioning, Disability, and Health framework. Summative content analysis summarized the results numerically. RESULTS Electronic and hand search identified 447 review publications for frailty indices; nine reviews that included a total of 135 unique frailty indices. The search for generic and HIV-related HRQL measures identified 2008 records; five reviews that identified 35 HRQL measures (HIV-specific: 17; generic: 18). Of the 135 frailty indices, 88 cover more than one frailty dimension and 47 cover only physical frailty. Contributors to frailty, like sensory symptoms and nutrition, are extensively covered. Components of frailty such as physical capacity, cognitive ability, and mood are also extensively covered. Consequences of frailty namely self-rated health, falls, hospitalization, and health services utilization are incomprehensively covered. HRQL measures are informative for contributing factors, components of frailty, and a consequence of frailty. CONCLUSION HRQL items and measures show a strong potential to operationalize multidimensional frailty and physical frailty. The study suggests that these measures, connected to evidence-based interventions, could be pivotal in directing resources toward vulnerable populations to mitigate the onset of frailty.
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Affiliation(s)
- Mehmet Inceer
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center (RI-MUHC), Montreal, QC, Canada.
- Patient Centered Solutions, IQVIA, Montreal, QC, Canada.
| | - Nancy Mayo
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center (RI-MUHC), Montreal, QC, Canada
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Melo GC, Carvalho ACA, Mendes MLT, do Nascimento RO, de Araújo KCGM, Tanajura DM, Santos VS, Martins-Filho PR. Association between frailty phenotype, quantification of plasma HIV-1 RNA, CD4 cell count and HAART in HIV-positive subjects: a systematic review and meta-analysis of observational studies. AIDS Care 2022; 34:1159-1168. [PMID: 34292108 DOI: 10.1080/09540121.2021.1956414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
HIV infection causes a constant activation of the immune system and contributes to an enhanced systemic pro-inflammatory cytokine milieu, which has been associated with premature aging and frailty. We performed a systematic review and meta-analysis to analyze whether the HIV-1 RNA load, CD4+ T-lymphocyte counts and exposure to HAART in HIV-positive subjects are associated with frailty phenotype. Searches were performed in PubMed, SCOPUS, Lilacs, Web of Science, Google Scholar, and OpenThesis databases. We used the odds ratio as a measure of the association. We used either a fixed or random-effects model to pool the results of individual studies depending on the presence of heterogeneity. Eleven studies were included in the review. Data from 8035 HIV-positive subjects were analyzed; 2413 of the subjects had viral load detectable, 981 had a CD4T-cell count <350 cells/μL, and 1342 had HAART exposure information. We found an association between frailty and CD4T-cell count <350 cells/μL (OR 2.68, CI 95% 1.68-4.26, I2 = 46%), HIV-1 RNA load detectable (OR 1.71, CI 95% 1.38-2.12, I2 = 0%), and protease inhibitor-containing HAART regimen (OR 2.21, CI 95% 1.26-3.89, I2 = 0%). Further studies are necessary to evaluate the effects of other factors on the development of clinical features related to frailty.
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Affiliation(s)
| | - Aline Carla Araújo Carvalho
- State University of Health Sciences of Alagoas, Maceió, Brazil.,Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Brazil.,Cesmac University Center, Maceió, Alagoas, Brazil
| | | | | | | | - Diego Moura Tanajura
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - Victor Santana Santos
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
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Han S, Hu Y, Pei Y, Zhu Z, Qi X, Wu B. Sleep satisfaction and cognitive complaints in Chinese middle-aged and older persons living with HIV: the mediating role of anxiety and fatigue. AIDS Care 2021; 33:929-937. [PMID: 33487030 DOI: 10.1080/09540121.2020.1844861] [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] [Indexed: 10/22/2022]
Abstract
Middle-aged and older persons living with HIV (PLWH) suffer from sleep distress and cognitive disorders due to HIV infection and aging. We aim to explore the relationship between sleep satisfaction and cognitive complaints, and the mediating role of anxiety and fatigue in this relationship among middle-aged and older PLWH. We used data from a multicenter cross-sectional study in China (Shanghai, Kunming, Nanning, Hengyang, and Changning) conducted in 2017. The data analysis included 435 PLWH aged 45 years and over. Multiple linear regression models showed that worse sleep satisfaction was significantly associated with lower cognitive complaints after controlling for anxiety, fatigue, demographic variables, and clinical variables (β = -0.246, p < 0.01). Both anxiety and fatigue were significant partial mediators in the relationship between sleep satisfaction and cognitive complaints. The serial multiple mediation models of sleep satisfaction-anxiety (M1)-fatigue (M2)-cognitive complaints were supported and the alternative model of sleep satisfaction-fatigue (M2)-anxiety (M1)-cognitive complaints were both supported. Our study indicates that it is important to improve sleep quality to promote cognitive function among Chinese middle-aged and older PLWH. Prevention and treatment programs for sleep satisfaction and cognitive function should include the assessment and reduction of fatigue and anxiety.
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Affiliation(s)
- Shuyu Han
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, People's Republic of China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, People's Republic of China
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, People's Republic of China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, People's Republic of China
| | - Xiang Qi
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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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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Justice AC, Tate JP. Ageing with and without HIV: will advanced age bring equity or greater disparity? J Int AIDS Soc 2019; 22:e25400. [PMID: 31571414 PMCID: PMC6769376 DOI: 10.1002/jia2.25400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Amy C Justice
- Veterans Affairs Connecticut Healthcare SystemWest HavenCTUSA
- School of MedicineYale UniversityNew HavenCTUSA
- School of Public HealthYale UniversityNew HavenCTUSA
| | - Janet P Tate
- Veterans Affairs Connecticut Healthcare SystemWest HavenCTUSA
- School of MedicineYale UniversityNew HavenCTUSA
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Morgello S, Gensler G, Sherman S, Ellis RJ, Gelman BB, Kolson DL, Letendre SL, Robinson-Papp J, Rubin LH, Singer E, Valdes-Sueiras M. Frailty in medically complex individuals with chronic HIV. AIDS 2019; 33:1603-1611. [PMID: 31305330 PMCID: PMC6760300 DOI: 10.1097/qad.0000000000002250] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Multimorbidity and frailty are consequences of aging with HIV, yet not everyone with medical disease is frail. Our objective was to identify factors associated with frailty in a multimorbid HIV-infected cohort. DESIGN Analysis of a prospective, observational, longitudinal cohort. METHODS Three hundred and thirty-two participants in the medically advanced National NeuroAIDS Tissue Consortium (NNTC) study were categorized as frail, prefrail, or robust with the Fried Frailty Index. A series of logistic regression analyses (first univariate, then multivariable) were conducted to determine whether medical comorbidities, immunologic and virologic parameters, and/or neuropsychiatric variables predicted increased odds of frailty. RESULTS The mean number of medical comorbidities per participant was 2.7, mean CD4 T-cell count was 530 cells/μl, and 77% had undetectable HIV RNA in blood. Twenty-two percent were frail, 55% prefrail, and 23% robust. Significant predictors of frailty in multivariable analysis were cognitive diagnosis rendered by Frascati criteria, depressive symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and sex. Men were less likely to be frail than women. Higher odds of frailty were seen with: symptomatic, but not asymptomatic, cognitive impairment (compared with cognitive normals); more depressive symptoms; diabetes mellitus; and COPD. CONCLUSION Neuropsychiatric illness increased odds of being frail on a predominantly physical/motoric measure, but only when symptomatic. Lack of association with asymptomatic impairment may reflect the importance of functional limitation to frailty, or possibly a unique resilience phenotype. Understanding why sex and symptomatic neuropsychiatric illness are associated with frailty will be important in managing HIV-associated morbidity in aging populations.
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Affiliation(s)
- Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York
- Departments of Neuroscience and Pathology, ISMMS, New York, New York
| | | | | | - Ronald J Ellis
- Departments of Neurosciences and Psychiatry, University of California, San Diego, California
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Dennis L Kolson
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott L Letendre
- Departments of Psychiatry and Medicine, University of California, San Diego, California
| | - Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York
| | - Leah H Rubin
- Departments of Neurology and Epidemiology, Johns Hopkins Schools of Medicine and Public Health, Baltimore, Maryland
| | - Elyse Singer
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Miguel Valdes-Sueiras
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Schoepf IC, Buechel RR, Kovari H, Hammoud DA, Tarr PE. Subclinical Atherosclerosis Imaging in People Living with HIV. J Clin Med 2019; 8:jcm8081125. [PMID: 31362391 PMCID: PMC6723163 DOI: 10.3390/jcm8081125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
In many, but not all studies, people living with HIV (PLWH) have an increased risk of coronary artery disease (CAD) events compared to the general population. This has generated considerable interest in the early, non-invasive detection of asymptomatic (subclinical) atherosclerosis in PLWH. Ultrasound studies assessing carotid artery intima-media thickness (CIMT) have tended to show a somewhat greater thickness in HIV+ compared to HIV−, likely due to an increased prevalence of cardiovascular (CV) risk factors in PLWH. Coronary artery calcification (CAC) determination by non-contrast computed tomography (CT) seems promising to predict CV events but is limited to the detection of calcified plaque. Coronary CT angiography (CCTA) detects calcified and non-calcified plaque and predicts CAD better than either CAC or CIMT. A normal CCTA predicts survival free of CV events over a very long time-span. Research imaging techniques, including black-blood magnetic resonance imaging of the vessel wall and 18F-fluorodeoxyglucose positron emission tomography for the assessment of arterial inflammation have provided insights into the prevalence of HIV-vasculopathy and associated risk factors, but their clinical applicability remains limited. Therefore, CCTA currently appears as the most promising cardiac imaging modality in PLWH for the evaluation of suspected CAD, particularly in patients <50 years, in whom most atherosclerotic coronary lesions are non-calcified.
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Affiliation(s)
- Isabella C Schoepf
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, 8091 Zurich, Switzerland
| | - Dima A Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland.
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