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

October 6, 2020

Featured Literature:

Verheij E et al. Frailty Is Associated with Mortality and Incident Comorbidity Among Middle-Aged Human Immunodeficiency (HIV) – Positive and HIV-Negative Participants. Clin Infect Dis 2020; 222:919-928 and 2020; 222:883-884.

Frailty phenotype was first used approximately 20 years ago in persons > 65 years to predict morbidity and mortality. Components of frailty include unintentional weight loss, low physical activity, slow walking speed, self-reported exhaustion, and poor grip strength. Numerous studies in persons with HIV have reported onset of frailty as early as age 45. This study assessed 598 HIV-positive and 550 comparable HIV-negative persons from the AGEhIV Cohort in the Netherlands. Patients were very comparable between the two groups, with the majority being MSM. The authors looked at the impact of frailty on all-cause mortality during six years of follow-up and looked at incident co-morbidities (HTN, COPD, kidney disease, osteoporosis) at four years of follow-up. The mortality rate was 25.7/1000 person years among frail participants compared to only 7.2 in those considered pre-frail and only 2.3 in those noted to be non-frail or “robust”. It was found that frailty remained independently associated with mortality, even after adjusting for age, smoking, alcohol use, and HIV status. Comorbidities occurred in 31% of the frail participants but only 14% of those who were robust.  Unexpectedly, the overall presence of comorbidities was also not significantly related to HIV status.

Author’s Commentary:

This study found that frailty increases the risk of death and comorbidities independent from other risk factors including HIV. That being said, the onset of frailty occurred at a relatively young age in both groups from this cohort. An accompanying editorial notes that studies have shown frailty to increase risk of falls or institutionalization that subsequently leads to premature death. Whether interventions for persons who are pre-frail or robust to maintain or improve physical function remains to be proven, but clinically makes sense.  More longitudinal studies in PWH looking for inflammatory, immunologic and genetic factors that may drive frailty are needed. In the interim, one of the most important pieces of advice we can give to our patients is to keep moving – every day.

The author has no conflicts of interest to disclose.

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