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Frailty may predict mortality in nongeriatric patients with HIV
Frailty was identified as a strong predictor of mortality and incident comorbidity regardless of other risk factors among HIV-positive and HIV-negative populations who were not yet classified as geriatric, according to a recent study.
“With the use of combination ART (cART), the life expectancy of people living with HIV (PWH) has notably improved. ... NonAIDS-defining comorbidities have thereby gained increased importance as causes of morbidity and mortality,” Eveline Verheij, MD, of Amsterdam University Medical Centers, and colleagues wrote. “Consequently, identifying PWH at increased risk of poor outcomes as they age has become a research priority with important implications for clinical management.”
Verheij and colleagues assessed the effect of frailty — which encompassed five variables, including weight loss, low physical activity, exhaustion, decreased grip strength and slow gait speed, for the purposes of this study — on all-cause mortality and incident comorbidity. They also used multivariable Cox and logistic regression models to evaluate the independent relationships of frailty with both all-cause mortality and incident comorbidity, adjusting for HIV infection and traditional risk factors.
The study included 598 patients with HIV and 550 comparable participants without HIV in the AGEhIV Cohort Study. All patients were aged 45 years and older.
At baseline, 86 of the participants (7.5%) were considered frail. During the follow-up period, 38 participants died.
Mortality rates per 1,000 person-years of follow-up were significantly higher among frail participants (25.7; 95% CI, 14.2-46.4) vs. patients who were considered prefrail (7.2; 95% CI, 4.7-11.2) or robust (2.3; 95% CI, 1.1-4.9; P < .001 for both comparisons). After performing fully adjusted analyses — adjusting for HIV infection and traditional risk factors — researchers found that frailty continued to be strongly correlated with death (HR = 4.6; 95%, CI, 1.7-12.5) and incident comorbidity (OR = 1.9; 95%, CI, 1.1-3.1). No interactions between frailty and HIV status were demonstrated in any analyses.
“Frailty was a strong predictor of mortality and incident comorbidity in this predominantly middle-aged population [of patients with HIV], which, whilst ageing, would not yet be considered of geriatric age. Moreover, frailty impacted the risk of these adverse outcomes independently from other recognized risk factors,” the authors concluded. “Future studies should investigate if such interventions may similarly modify the frailty-phenotype in ageing PWH to reduce their risk of morbidity and mortality.” – by Caitlyn Stulpin
Disclosures: Verheij reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.