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Observational Study
. 2019 Sep 27;69(8):1370-1376.
doi: 10.1093/cid/ciy1101.

Frailty Is an Independent Risk Factor for Mortality, Cardiovascular Disease, Bone Disease, and Diabetes Among Aging Adults With Human Immunodeficiency Virus

Sean G Kelly  1 , Kunling Wu  2 , Katherine Tassiopoulos  2 , Kristine M Erlandson  3 , Susan L Koletar  4 , Frank J Palella  5
Affiliations
Observational Study

Frailty Is an Independent Risk Factor for Mortality, Cardiovascular Disease, Bone Disease, and Diabetes Among Aging Adults With Human Immunodeficiency Virus

Sean G Kelly et al. Clin Infect Dis. .

Abstract

Background: We characterized associations between frailty and incident cardiovascular disease (CVD), diabetes mellitus (DM), bone disease, and mortality within a cohort of aging persons with human immunodeficiency virus (PWH).

Methods: Participants underwent frailty evaluations using the Fried frailty assessment (baseline and annually). Frailty was defined as having ≥3 frailty criteria. Clinical outcomes of mortality, CVD events, DM, and bone disease events were recorded throughout the study period (baseline to most recent study or clinic visit, or date of clinical outcome, whichever came first). Poisson regression models were used to evaluate associations between baseline frailty, change in frailty score over 48 weeks, and each clinical outcome.

Results: Among 821 men and 195 women (median age 51 years), 62 (6%) were frail at baseline. Frailty scores increased by ≥1 component among 194 participants (19%) from baseline to 48 weeks. Baseline frailty was associated with an increased risk of incident CVD and DM, with a trend toward a significant association with bone events. Among frailty components, slow gait speed was associated with incident DM and borderline associated with incident CVD. An increase in frailty from baseline to week 48 was associated with mortality but not with the other clinical outcomes.

Conclusions: Baseline frailty was associated with multiple adverse health outcomes (incident CVD, DM, and bone disease), while increase in frailty score was associated with mortality among PWH engaged in care. Incorporation of frailty assessments into the care of PWH may assist in improvement of functional status and risk stratification for age-related chronic diseases.

Keywords: chronic diseases; frailty; human immunodeficiency virus; mortality.

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Figures

Figure 1.
Figure 1.
Multivariable associations between baseline frailty, grip strength, gait speed, and rates of incident events. Each panel summarizes 3 separate multivariable models: frail/pre-frail and incident event, grip strength and incident event, walk speed and incident event. Model for CVD adjusted for route of human immunodeficiency virus (HIV) transmission, with age, history of diabetes, smoking, hyperlipidemia, hypertension, and family history of CVD forced in as covariates. Model for diabetes, with age, race/ethnicity, family history of diabetes, body mass index, and hyperlipidemia forced in as covariates. Model for bone disease, with age forced in as a covariate. Model for mortality adjusted for sex, history of diabetes, and route of HIV transmission, with age forced in as a covariate. Abbreviations: CI, confidence interval; CVD, cardiovascular disease. *Slow gait speed is defined as >4 seconds for a 4-meter walk.
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