Frailty is a Predictor for Mortality in Adults With and Without HIV

Independent from other risk factors, frailty can be a strong predictor for both mortality and incident comorbidity among adults of middle age, according to a new report from The Journal of Infectious Diseases. This was true for people with and without HIV, the study authors said.

Investigators from Amsterdam studied more than 1000 middle-aged adult patients in order to understand the impact of frailty among the aging population with HIV. The investigators compared 598 middle aged to older adults living with HIV and 550 adults who did not have HIV that were all over the age of 45 years.

Now that people with HIV are living longer due to antiretroviral therapy non-AIDS-related comorbidities are increasing. The study investigators wanted to identify people with HIV who were at an increased risk for poor outcomes as they age to pinpoint what research should be prioritized moving forward. Then, in turn, it would help in figuring out what implications these findings hold for the patients’ health care management.

The investigators said defined frailty as weight loss, low physical activity, exhaustion, decreased grip strength, and slow gait speed. If a person met 3 or more of these characteristics, they were considered frail; if they met 1-2, they were “prefrailty.”

At baseline, 7.5% of the patients met the definition for frailty. Then, the patients were tracked for follow-up for 6 years to measure incident all-cause mortality and 4 years to measure comorbidity. The investigators took hip and waist circumference measurements at each study visit. Additionally, waist-to-hip ratio, height, and weight were measured and blood samples were obtained. The participants also completed a questionnaire on smoking behavior, alcohol use, medication use, recreational drug use, and depressive symptoms.

A majority of these patients who were living with HIV were men who have sex with men. During the follow-up period, the investigators reported that 7.9% of the HIV-positive and 5.4% of the HIV-negative participants became frail. The investigators also observed that during the follow-up period, 56.9% of the participants with HIV and 49.3% of the HIV-negative participants became prefrail.

The frail participants more often were HIV-positive, a current smoker, and had more pre-existing comorbidities, the study authors said, while noting this group reported less alcohol use.

During the mortality follow-up for both groups, the study authors discovered that 38 patients died (31 from the HIV-positive group). Of the deceased participants, 11 were frail at baseline, 20 were prefrail and 7 were not. None of the deaths were AIDS-related, the study authors said.

Being frail was independently associated with an increased risk for mortality after adjustments for age, HIV status, smoking status, and alcohol use, the investigators reported.

There was no effect of HIV status on frailty or mortality, they added.

The measurements collected at the follow-up visits were not associated with mortality, the study authors said; they did not impact the link between frailty and mortality, either.

Some of the incident comorbidities included hypertension, COPD, decreased kidney function, and osteoporosis. These combined to make up almost three-quarters of the incident comorbidities, of which there were 320 total across both participant groups.

“Clinicians should be aware that frailty is predictive for future adverse health outcomes and may want to consciously screen their patients—even those who have not yet reached ‘geriatric’ age and do not yet have significant comorbidity for frailty in order to proactively identify those at greater risk of adverse health outcomes,” study author Eveline Verheij, a PhD candidate, told Contagion®. “Based on studies from the geriatric field in the general population, elderly patients living with HIV may be confident that lifestyle interventions such as increased physical activity may help prevent and maybe even reverse frailty, although this needs to be further investigated in the setting of HIV.”