Frailty Is Associated With Mortality and Incident Comorbidity Among Middle-Aged Human Immunodeficiency Virus (HIV)–Positive and HIV-Negative Participants. (20th January 2020)

• Record Type: Journal Article
• Authors: Verheij, Eveline; Kirk, Gregory D; Wit, Ferdinand W; van Zoest, Rosan A; Verboeket, Sebastiaan O; Lemkes, Bregtje A; Schim van der Loeff, Maarten F; Reiss, Peter
• Is Part Of: Journal of infectious diseases. Volume 222:Number 6(2020)
• Page Start: 919
• Page End: 928
• Publication Date: 2020-01-20
• Subjects: frailty -- mortality -- comorbidities -- HIV -- inflammation; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiaa010
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: Frailty is associated with mortality and morbidity in the general geriatric population, but less is known about its impact among the aging but generally younger population with human immunodeficiency virus (HIV). Methods: The impact of frailty on all-cause mortality during 6 years of follow-up and incident comorbidity during 4 years of follow-up was assessed among 598 HIV-positive and 550 comparable HIV-negative participants aged ≥ 45 years of the AGEh IV Cohort Study. Frailty encompasses 5 domains; weight loss, low physical activity, exhaustion, decreased grip strength, and slow gait speed. Presence of ≥ 3 denotes frailty, 1–2 prefrailty, and 0 robust. Multivariable Cox and logistic regression models were used to assess the independent relationships of frailty with both outcomes, adjusting for HIV infection and traditional risk factors. Results: At baseline, 7.5% (n = 86) of participants were frail. During follow-up, 38 participants died. Mortality rate was significantly higher among frail participants: 25.7/1000 person-years of follow-up (PYFU) (95% confidence interval [CI], 14.2–46.4) compared with prefrail (7.2/1000 PYFU [95% CI, 4.7–11.2]) and robust (2.3/1000 PYFU [95% CI, 1.1–4.9]). In fully adjusted analyses, frailty remained strongly associated with death (hazard ratio, 4.6 [95% CI, 1.7–12.5]) and incident comorbidity (odds ratio, 1.9 [95% CI, 1.1–3.1]). No interactions were observed between frailty and HIV status in all analyses. Conclusions: Frailty is a strong predictor of both mortality and incident comorbidity independent from other risk factors. Clinical Trials Registration: NCT01466582. Abstract : Frailty was a strong predictor of mortality and incident comorbidity in our HIV-positive and HIV-negative participants who, although aging, were not yet considered of geriatric age. Moreover, frailty impacted the risk of these outcomes independently from other recognized risk factors.