Frailty tied to CVD, DM, bone disease in aging adults with HIV

  • Kelly SG & al.
  • Clin Infect Dis
  • 24 Dec 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Frailty, increases in frailty scores over time in treated, virally suppressed middle-aged/older people living with HIV (PWH) are associated with increased risk for incident cardiovascular disease (CVD), diabetes mellitus (DM), and bone disease independent of traditional risk factors.

Why this matters

  • Incorporate frailty assessments in chronic disease risk stratification for older PWH.
  • Consider physical activity training to reverse or reduce frailty progression, improve outcomes.

Key results

  • 1016 participants (821 men, 195 women), median age 51 years.
  • 38% (n=390), 6% (n=62) were prefrail, frail at baseline, respectively. Frailty scores increased among 19% (n=194) of participants from baseline to week 48.
  • Baseline frailty was associated with increased incident CVD risk (incidence rate ratio [IRR], 3.83; 95% CI, 1.59-9.23; P=.003), incident DM (IRR, 2.29; 95% CI, 1.03-5.10; P=.04).
    •  A trend toward significant association with incident bone events also observed (IRR, 2.31; 95% CI, 0.96-5.52; P=.06).
  • Increase in frailty was significantly associated with mortality (IRR, 3.78; 95% CI, 1.52-9.39; P=.004).

Study design

  • Prospective, observational study assessing association between baseline frailty, changes in frailty over 48 weeks, and mortality, incident CVD, DM, and bone disease in aging PWH.
  • Funding: National Institute of Allergy and Infectious Diseases.

Limitations

  • Limited generalizability.
  • Underpowered to capture mortality.
  • Unmeasured confounding.
  • Self-report bias.