Comparison of functional status instruments in HIV-infected adults on effective antiretroviral therapy

Abstract

Background: The best method for assessment of functional status in human immunodeficiency virus type 1 (HIV-1) infected persons is unknown.

Objective: We hypothesized that 3 instruments to assess frailty or disability in elderly populations would perform similarly in HIV-1-infected persons.

Methods: HIV-infected subjects 45 to 65 years old with plasma HIV-1 RNA <48 copies/mL were classified prospectively as low, moderate, or high function by Fried's frailty phenotype (FFP), the Short Physical Performance Battery (SPPB), and 400-m walk test. Functional instrument agreement was evaluated by weighted kappa statistic, and relationships with demographic or clinical factors were evaluated by odds ratios (OR).

Results: There were 359 participants (85% male, mean age 52 years, mean CD4+ lymphocyte count 551 cells/µL) who were evaluated. Three percent to 8% were low, 31% to 51% were moderate, and 42% to 62% were high function. FFP, SPPB, and 400-m walk test had moderate agreement for functional classification (61%-64%; κ = 0.34-0.41). Across instruments, lower reported physical activity (OR ≯ 5.5; P ≤ .005), no current employment (OR ≯ 4.2; P < .02), arthritis (OR ≯ 6.5; P < .02), neurologic disease (OR ≯ 2.6; P < .05), debilitating pain (OR ≯ 5.4; P < .008), psychiatric disease (OR ≯3.1; P < .03), more comorbidities (OR ≯ 3.6; P ≤ .005), and more non-antiretroviral therapy medications (OR ≯ 3.5; P ≤ .01) were associated with lower function. Current CD4 <200 cells/µL was more likely among low-function (11%) than high-function (2%) persons on FFP (P = .04); other HIV-related characteristics were not significantly different (P > .05) between functional categories on any instrument.

Conclusions: Moderate functional impairment is common among middle-aged HIV-infected persons, with similar frequencies of impairment detected by 3 instruments. Reduction in comorbid disease, increased physical activity, and improved pain symptom management could reduce functional impairment among persons aging with HIV-infection.

Figure 1

Figure 1a. Adjusted odds of low versus high functional categorization by each assessment tool according to demographics Figure 1b. Adjusted odds of low versus high functional categorization by each assessment tool according to comorbid diagnoses Odds ratios with 95% confidence intervals are shown for each comparison. FFP, Fried’s Frailty Phenotype (circles); SPPB, Short Physical Performance Battery (squares); 400-m walk (triangles); ART, antiretroviral therapy.

Figure 1

Figure 1a. Adjusted odds of low versus high functional categorization by each assessment tool according to demographics Figure 1b. Adjusted odds of low versus high functional categorization by each assessment tool according to comorbid diagnoses Odds ratios with 95% confidence intervals are shown for each comparison. FFP, Fried’s Frailty Phenotype (circles); SPPB, Short Physical Performance Battery (squares); 400-m walk (triangles); ART, antiretroviral therapy.