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. 2013;8(1):e54910.
doi: 10.1371/journal.pone.0054910. Epub 2013 Jan 31.

Frailty, HIV infection, and mortality in an aging cohort of injection drug users

Damani A Piggott  1 , Abimereki D Muzaale, Shruti H Mehta, Todd T Brown, Kushang V Patel, Sean X Leng, Gregory D Kirk
Affiliations

Frailty, HIV infection, and mortality in an aging cohort of injection drug users

Damani A Piggott et al. PLoS One. 2013.

Abstract

Background: Frailty is associated with morbidity and premature mortality among elderly HIV-uninfected adults, but the determinants and consequences of frailty in HIV-infected populations remain unclear. We evaluated the correlates of frailty, and the impact of frailty on mortality in a cohort of aging injection drug users (IDUs).

Methods: Frailty was assessed using standard criteria among HIV-infected and uninfected IDUs in 6-month intervals from 2005 to 2008. Generalized linear mixed-model analyses assessed correlates of frailty. Cox proportional hazards models estimated risk for all-cause mortality.

Results: Of 1230 participants at baseline, the median age was 48 years and 29% were HIV-infected; the frailty prevalence was 12.3%. In multivariable analysis of 3,365 frailty measures, HIV-infected IDUs had an increased likelihood of frailty (OR, 1.66; 95% CI, 1.24-2.21) compared to HIV-uninfected IDUs; the association was strongest (OR, 2.37; 95% CI, 1.62-3.48) among HIV-infected IDUs with advanced HIV disease (CD4<350 cells/mm3 and detectable HIV RNA). No significant association was seen with less advanced disease. Sociodemographic factors, comorbidity, depressive symptoms, and prescription drug abuse were also independently associated with frailty. Mortality risk was increased with frailty alone (HR 2.63, 95% CI, 1.23-5.66), HIV infection alone (HR 3.29, 95% CI, 1.85-5.88), and being both HIV-infected and frail (HR, 7.06; 95%CI 3.49-14.3).

Conclusion: Frailty was strongly associated with advanced HIV disease, but IDUs with well-controlled HIV had a similar prevalence to HIV-uninfected IDUs. Frailty was independently associated with mortality, with a marked increase in mortality risk for IDUs with both frailty and HIV infection.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Survival by Frailty Status in the ALIVE cohort.
Kaplan Meier Survival Curve Estimates for 1230 ALIVE Participants from July 2005 to December 2008. Robust participants had a frailty score of 0; prefrail participants had a frailty score of 1–2; frail participants had a frailty score of 3–5.
Figure 2
Figure 2. Survival by Frailty and HIV Status in the ALIVE cohort.
Kaplan Meier Survival Curve Estimates for 1230 ALIVE Participants from July 2005 to December 2008. Frail- participants had a frailty score of 0–2; Frail+ participants had a frailty score of 3–5.
See this image and copyright information in PMC

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