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Reported by Jules Levin
20th International AIDS Conference, July 20-25, 2014, Melbourne
Audrey Lan, Miriam Morey, PhD, Tammy Chin, Lynn McNeil, RN, Barlett Humphries, Katherine Frankey, Carl Pieper, DPH, Charles Hicks, MD, Mehri McKellar, MD Duke University, Durham, North Carolina
“More than 50% of HIV-infected adults in the US will be >50 years old in 2015……There is growing concern among patients and healthcare providers that this group is experiencing a premature or ‘accelerated aging’ process……We determined that HIV-infected older adults on effective ART (with suppressed HIV-1 viral loads) had diminished physical performance results when compared to normal reference controls…..Physical function was significantly diminished in older HIV+ persons when compared to reference standards for HIV- age/gender-matched controls. The magnitude of differences observed may be associated with poorer health, more disabilities, longer hospital stays, and higher costs, thus warranting intervention.”
References: Bohannon(Age and Aging, 1997) for gait speed, Milanovic et at. (Clinical Interventions in Aging, 2013) for 30-second chair stands, Luna-Heredia et al. (Clinical Nutrition, 2005) for grip strength, Enright et al. (American Journal of Respiratory and Critical Care Medince, 1998) for 6 minute walk test.
Participants: 108 patients in the Duke HIV Clinic ≥50 years old.
Inclusion criteria: Age 50 or older, currently stable on ART for at least 6 months, with undetectable HIV-1 viral loads and no HIV-1 are in a >200 copies/mL in the prior 12 months.
Exclusion criteria: Active unstable angina, recent (<6 months) hx of myocardial infarction, hx of ventricular tachycardia, uncontrolled hypertension (diastolic BP >120 mm/Hg), recent (<6 months) hx of stroke or any residual neurological deficits affecting physical function, active substance abuse affecting participation in study, dementia or diagnosis of mental or behavioral disorders that preclude study participation, severe hearing or vision loss, and/or chronic pain that may limit performance testing.
Design: All patients completed a one-time visit to obtain demographics, vital signs, body mass index (BMI), estimated duration of HIV, types and dates of current/prior ART, HIV-associated complications and opportunistic infections, additional medical conditions, lifestyle habits, nadir and current CD4 counts, and initial/baseline HIV-1 viral loads. Statistics were calculated with the MEANS procedure and the Wilcoxon two-sample test.³
Physical Performance Tests:
Overall demographics and clinical characteristics
|CD4 nadir <200
|CD4 nadir ≥350
|50–59 years old||53 (49%)||37 (51%)||16 (46%)|
|60–69 years old||49 (45%)||31 (42%)||18 (51%)|
|≥70 years old||6 (6%)||5 (7%)||1 (3%)|
|Male||76 (70%)||50 (60%)||26 (74%)|
|Female||32 ( 30%)||23 (32%)||9 (26%)|
|Black/African-American||64 (59%)||48 (66%)||16 (46%)|
|White/Caucasian||41 (38%)||23 (31%)||18 (51%)|
|Hispanic||3 (3%)||2 (3%)||1 (3%)|
|<25 kg/m²||28 (26%)||21 (29%)||7 (20%)|
|25–29.9 kg/m²||43 (40%)||30 (41%)||13 (37%)|
|>30 kg/m²||37 (34%)||22 (30%)||15 (43%)|
Physical Performance Results Compared to Age/Gender-Matched Reference Ranges
|n||Did Difference From Norms||Clinically Significant Meaningful Difference|
|Gait Speed – Usual Speed (m/s)||108||-0.20 ± 0.25||>0.1 m/s|
|Gait Speed – Maximal Speed (m/s)||108||-0.21 ± 0.37||>0.1 m/s|
|30-Second Chair Stand*||55||-1.11 ± 4.06||Not established|
|Grip Strength (kg)||108||-3.89 ± 8.89||Not established|
|6-Minute Walk Distance (m)*||107||-105.15 ± 100.93||>50 m|
*No reference values were found for the 50–59 age group. One subject did not perform this test.
|Total (n=108)||<200 cells/mm³ (n=73)||≥350 cells/mm³ (n=35)||p-value||Normal or Desired Value|
|Gait Speed – Usual Speed (m/s)||1.17 ± 0.83||1.15 ± 0.79||1.20 ± 0.92||0.36||>1.2|
|Gait Speed – Maximal Speed (m/s)||1.76 ± 0.37||1.76 ± 0.39||1.77 ± 0.34||0.74||N/A|
|30-Second Chair Stand||12.67 ± 4.12||12.66 ± 4.31||12.69 ± 3.76||0.86||>16|
|Grip Strength (kg)||33.36 ± 9.62||33.19 ± 9.43||33.70 ± 10.14||0.83||N/A|
|6-Minute Walk Distance (m)||428.38 ± 109.55||421.55 ± 111.34||442.64 ± 105.87||0.55||>597|
*Note: ≥1.2 m/s is considered the walking speed needed to safely cross the street.
The authors would like to thank the subject for their participation. This work was supported by an investigator-initiated grant from the Duke University Center for AIDS research (CFAR Grant number AI064518), The Duke Pepper OAIC (OAIC grant number P30 AG028716), and the Duke Department of Medicine.
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