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Poor Prognosis for Frail Patients with HIV

— Simple frailty index predicted worse outcomes

Last Updated July 30, 2018
MedpageToday

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AMSTERDAM – Patients living with HIV infection had a higher risk of mortality and of developing an additional comorbidity when they registered as frail on a simple test, researchers said here.

The all-cause mortality for patients with HIV infection was 5.2 per patient-years of follow-up compared with 3.8 person-years of follow-up if the patient was not judged as frail – whether the individual did or did not have HIV (P<0.001), said Eveline Verheij, MD, a PhD candidate at the Academic Medical Center in Amsterdam.

In her oral presentation at the , Verheij said she and colleagues developed a frailty scale to determine how the condition affects mortality. Components included slow gait, low grip strength, exhaustion, low physical activity, and weight loss.

The research team devised a score in which a positive response on three or more of the criteria meant a person was "frail," and a score of 1-2 identified people who were "pre-frail," and a score of 0 was applied to individuals described as robust.

"Frailty was more prevalent among middle-age people living with HIV," Verheij said. "Frailty had a strong impact on the risk of incident comorbidity and mortality -- independent of HIV status."

Even when the investigators modeled their results with HIV-infection status, age, and the number of comorbidities, it still appeared that a high frailty score translated to a significantly increased risk of mortality.

Compared with the non-HIV patients, those who had HIV were more likely to be frail at every age stratification, and were less likely to be robust, Verheij reported. Overall, 8.5% of the HIV subjects were frail, compared with 3.4% of the patients not infected with HIV.

She said that in considering just HIV-infected persons, univariate analysis helped when the model was adjusted for age, HIV risk group, ethnicity, and education, but the effect was attenuated by including differences in waist-to-hip measurements. And the results were no longer significant if the number of comorbidities was included or if the model was adjusted for depressive symptomatology.

The multi-stage study enrolled 550 HIV-negative persons with a mean age of 52.1 -- 70.2% of whom were men who had sex with men, and 61.1% had no other comorbidities. These individuals were compared with 596 others who were HIV-positive. Mean age for them was approximately 52.7; 75.8% were men who had sex with men, and about 48.3% were free of other comorbidities.

The HIV cohort had been diagnosed with infection for about 12 years, and 95.8% were on antiretroviral therapy at the time of enrollment in the study. About one-third of the group had a history of an AIDS-defining event.

The co-chair of the session at which the data were presented, Cissy Kityo Mutuluuza, MD, deputy director of the Joint Clinical Research Center, a venture of the Uganda Ministry of Health and Makaree University in Kampala, told ֱ: "Frailty could be used as a screening tool so you can make long-term judgments among patients you are putting on long-term medications. We should be screening people for frailty."

Also commenting, Priscilla Hsue, MD, of the University of California San Francisco, said that the study was done with a large group of patients, one of the first studies to link frailty to mortality. "It makes sense," she said. "If you can't do hand grips, you probably have a lot of problems."

Disclosures

Verheij, Hsue, and Mutuluuza disclosed no relevant relationships with industry.

Primary Source

International AIDS Conference

Verheij E, et al "Increased risk of both mortality and incident comorbidity among frail HIV-positive and HIV-negative participants in the AGEhIV Cohort Study, and increased risk of frailty progression in those with HIV" IAC 2018.