CLINICAL CORNER

by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

April 11, 2019


Featured Literature:

Crane, HM et al. Physical functioning among patients aging with Human Immunodeficiency Virus (HIV) Versus HIV-Uninfected: Feasibility of using the Short Physical Performance Battery in clinical care of people living with HIV aged 50 or older. Open Forum Infectious Diseases. April 2, 2019 https://academic.oup.com/ofid/article/6/3/ofz038/5374626

The Short Physical Performance Battery (SPPB) has been used for about 20 years to measure physical performance and functional status in older adults. This short series of tests includes a timed 4-meter walk, standing balance in three positions, and chair-stand-to sit testing. Each measure in the SPPB is assigned a score from 0 to 4. A score of 0 indicates inability to complete the test and the summary score ranges from 0 to 12. This study applied SPPB testing to people living with HIV (PLWH) aged >50 at three HIV clinical sites in Alabama, North Carolina, and Washington and compared their performance scores with HIV-negative individuals. The comparator group included adults aged 70-79 from the Health, Aging, and Body Composition (Health ABC) study.

The study sites evaluated 176 PLWH with the SPPB and the mean completion time took only 7.0 minutes per patient. The overall mean SPPB score in PLWH was 10.3 compared to 10.1 in the HIV-uninfected group. A similar percentage of all subjects had scores <8 – which correlates with substantial impairment. Sub-scores for the different domains were similar in both groups despite the significant differences in age. Overall, functional status among PLWH appears to be similar to that of healthy uninfected adults who are about 20 years older. The authors believe this pilot study demonstrates the feasibility of applying the SPPB into clinical care of older PLWH. A six to eight-minute time period could be integrated into the clinic visit and done either before or after the patient is seen by a medical provider.


Commentary:
As noted in this study, the SPPB may be considered as part of the routine assessment of our aging HIV patients. Another small study using SPPB found an increase in mortality for PLWH with a score < 10. Additional data from other cohorts should provide further validation of this screening tool. In addition, for the SPPB to truly useful, interventions to improve outcomes in PLWH with positive screens for gait disorders and other signs of frailty will be needed.

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