In the Journals Plus

Frailty associated with adverse health outcomes, mortality in HIV-infected adults

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January 2, 2019

Study findings showed that frailty is associated with risk for incident cardiovascular disease, diabetes mellitus and bone disease in people living with HIV, and that an increase in frailty is associated with mortality in patients with HIV who are engaged in care.

Researchers said incorporating frailty assessments in standard HIV care could have benefits for patients.

“As potent antiretroviral therapy (ART) has markedly improved survival of persons with HIV (PWH), chronic age-related diseases have emerged as predominant causes of death among ART-treated persons. These conditions disproportionally affect aging PWH and include cardiovascular disease (CVD), metabolic diseases, and bone demineralization,” Sean G. Kelly, MD, assistant professor of medicine at Vanderbilt University Medical Center, and colleagues wrote.

“Further compromising health among aging PWH is frailty, a syndrome of dysregulation of multiple biologic systems that leads to physical weakness and functional decline. Frailty prevalence increases with age after age 65 in the general population; however, it has been observed to occur up to a decade earlier among PWH and is associated with excess burden of mortality and morbidity.”

Kelly and colleagues said frailty’s role as a predictor for the development of specific age-related chronic diseases among PWH is not well understood. For their study, they evaluated patients using the Fried’s frailty assessment, which includes five components: weak grip, slow gait speed on a 4-meter walk, self-reported weight loss, exhaustion and limitations in ability to undertake vigorous physical activity. A participant was determined to be frail if they met three or more of the frailty criteria. Kelly and colleagues also recorded clinical outcomes of mortality, CVD, diabetes mellitus (DM) and bone disease events, as well as changes in frailty, throughout the study period.

According to the researchers, 821 men and 195 women were monitored during the study, with 6% (n = 62) determined to be frail and 38% (n = 390) pre-frail at baseline. Frailty scores increased in 19% (n = 194) of participants through 48 weeks, with frailty components including weight loss, low physical activity, exhaustion, grip weakness and slow gait speed.

Through monitoring, researchers determined that baseline frailty was associated with an increased risk for CVD and DM, “with a trend toward a significant association with incident bone events.” Additionally, an increase in frailty from baseline to week 48 was associated with mortality but not with other clinical outcomes.

“We found that the presence of frailty and increases in frailty scores over time among treated, virally suppressed PWH preceded multiple chronic disease-specific events and mortality. Routine incorporation of annual frailty assessments in the care of PWH, perhaps beginning as early as the sixth decade of life, can enhance the characterization of age-related functional declines, and may thereby aid in risk stratification for the development of age-associated chronic diseases,” Kelly and colleagues concluded. “Further, frailty may comprise a modifiable target for interventions aimed at improvement of functional status and, potentially, co-morbidity avoidance.” – by Caitlyn Stulpin

Disclosures: Kelly reports no relevant financial disclosures. Please see the study for all other authors relevant financial disclosures.

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