Frailty Is Associated With Mortality and Incident Comorbidity Among Middle-Aged Human Immunodeficiency Virus (HIV)-Positive and HIV-Negative Participants

Abstract

Background: Frailty is associated with mortality and morbidity in the general geriatric population, but less is known about its impact among the aging but generally younger population with human immunodeficiency virus (HIV).

Methods: The impact of frailty on all-cause mortality during 6 years of follow-up and incident comorbidity during 4 years of follow-up was assessed among 598 HIV-positive and 550 comparable HIV-negative participants aged ≥ 45 years of the AGEhIV Cohort Study. Frailty encompasses 5 domains; weight loss, low physical activity, exhaustion, decreased grip strength, and slow gait speed. Presence of ≥ 3 denotes frailty, 1-2 prefrailty, and 0 robust. Multivariable Cox and logistic regression models were used to assess the independent relationships of frailty with both outcomes, adjusting for HIV infection and traditional risk factors.

Results: At baseline, 7.5% (n = 86) of participants were frail. During follow-up, 38 participants died. Mortality rate was significantly higher among frail participants: 25.7/1000 person-years of follow-up (PYFU) (95% confidence interval [CI], 14.2-46.4) compared with prefrail (7.2/1000 PYFU [95% CI, 4.7-11.2]) and robust (2.3/1000 PYFU [95% CI, 1.1-4.9]). In fully adjusted analyses, frailty remained strongly associated with death (hazard ratio, 4.6 [95% CI, 1.7-12.5]) and incident comorbidity (odds ratio, 1.9 [95% CI, 1.1-3.1]). No interactions were observed between frailty and HIV status in all analyses.

Conclusions: Frailty is a strong predictor of both mortality and incident comorbidity independent from other risk factors.

Clinical trials registration: NCT01466582.

Keywords: HIV; comorbidities; frailty; inflammation; mortality.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.

Figures

Figure 1.

Kaplan–Meier cumulative mortality curve for the 1146 participants of the AGEhIV Cohort for all-cause mortality by frailty status at enrollment from October 2010 until October 2018. Follow-up time was censored at date of death, the fourth study visit, withdrawal of consent, loss to follow-up, or 6 years after inclusion for participants who did not complete their fourth study visit. Participants who missed 2 consecutive study visits were considered lost to follow-up and were censored at time of the first missed study visit. Frailty was defined based on the presence of ≥ 3 criteria, “prefrail” if 1–2 criteria were present, and “robust” when none of the criteria were met. The numbers of participants at risk are noted in the table below the graph.