Abstract
Background Neurocognitive impairment (NCI) is strongly associated with frailty in people living with human immunodeficiency virus (PLWH); the overlap of frailty and NCI and the impact on health outcomes in PLWH are unknown. Methods PLWH in a longitudinal, observational study of aging completed entry evaluations for frailty and NCI. Outcomes of falls (recurrent) increased limitations in independent activities of daily living (IADL), or mortality were combined. Poisson regression models estimated prevalence ratios (PR) for ≥1 outcome over 2 years. Results Among 987 participants, the median age at entry was 51 years; 19% were female; the median CD4 count was 616 cells/μL; and HIV-1 RNA was <200 copies/mL in 94%. Most (79%) participants had neither frailty nor NCI; 2% had both; 4% frailty only; and 15% NCI only. Over 2 years of observation, 100 (10%) participants experienced recurrent falls; 175 (18%) had worsening IADL limitations; 17 (2%) died; and 254 (26%) experienced ≥1 poor health outcome. In adjusted models, frailty with NCI was associated with more than double the risk of a poor health outcome (PR 2.65; 95% CI 1.98, 3.54); a significant association was also seen with frailty alone (PR 2.26; 95%CI 1.71, 2.99) and NCI alone (PR 1.73; 95% CI 1.36, 2.20). Conclusions The presence of frailty with NCI was associated with a greater risk of falls, disability, or death in PLWH than NCI alone. Interventions that target prevention or reversal of both frailty and NCI (such as increased physical activity) may significantly limit poor health outcomes among PLWH.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 131-138 |
| Number of pages | 8 |
| Journal | Clinical Infectious Diseases |
| Volume | 68 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2019 |
Funding
Potential conflicts of interest. K. M. E. has received grant support from Gilead Sciences and Merck, and has served as a consultant for Theratechnologies, EMD Serono, and Gilead Sciences. R. K. receives grant support from Gilead Sciences and has consulted for Gilead Sciences and Theratechnologies. F. J. P. is a consultant and/or on the speakers bureau for Gilead Sciences, Janssen Pharmaceuticals, Merck and Co. and ViiV. B. T. has received honoraria and/or grant support to Northwestern University from ViiV Healthcare, Gilead Sciences, Glaxo Smith Kline, and Janssen. K. R. has consulted for ViiV. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Financial support. This work was supported by the National Institute of Aging of the National Institutes of Health (grants numbers K23AG050260 and R01AG054366 to K. M. E.) and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Numbers UM1 AI068634, UM1 AI068636, and UM1 AI106701. This research was also supported by the Veterans Administration Geriatric Research Educational and Clinical Centers, Louis Stokes Cleveland Veterans Administration Medical Center (grant number VISN10 to R. K.).
Keywords
- HIV
- disability
- falls
- frailty
- neurocognitive impairment
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases
