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“In this study population over age 50 50% of participants had frailty or pre-frailty at higher frequencies than HIV-negatives…..49% had been exposed to zidovudine, stavudine or didanosine. Subjects had a median of 4 (IQR 3-6) co-morbidities.” Pre-frailty and difficulty with IADLs were the most frequent syndromes, occurring in 50% of participants.
Reported by Jules Levin
CROI 2014 March 3-6 Boston, MA
Meredith Greene MD1, Victor Valcour1, Yinghui Miao1,2, Ken Covinsky1,2, Joy Madamba1, Monica Mattes3, Harry Lampiris1,2, Jeffrey Martin1, Steven Deeks1
1. University of California, San Francisco, 2. San Francisco VA Medical Center, San Francisco, CA, 3. University of Central Florida College of Medicine
Background: Geriatric syndromes such as falls, frailty, and functional impairment are multifactorial conditions used to identify vulnerable older adults. We hypothesized that these conditions would be common among virally-suppressed HIV-infected older adults and that both HIV and non-HIV related factors would be associated with the presence of geriatric syndromes.
Methodology: We conducted a cross-sectional study within a San Francisco-based research cohort of HIV-infected adults age 50 and older who had an undetectable plasma HIV RNA on cART for at least 3 years. We measured frequencies of four geriatric syndromes: (1) falls (yes/no to fall in past year), (2) urinary incontinence (yes/no based on the International Consultation on Incontinence Questionnaire), (3) functional impairment, and (4) frailty (Fried’s criteria). Functional impairment was defined as difficulty with activities of daily living (e.g. dressing, bathing) and instrumental activities of daily living (e.g. shopping, housework). Potential correlates included sociodemographics, number of co-morbidities and non-antiretroviral medications, and HIV-specific variables (e.g. proximal and nadir CD4, length of HIV infection, exposure to certain antiretroviral drugs), which were examined in multivariate analyses using relative risk estimation by Poisson regression.
Results: 142 subjects were enrolled, of which 94% were male and 63% were Caucasian with a median age of 57 (range 50-74). The median CD4 count was 577 (IQR 393-715), median CD4 nadir was 172 (IQR 50-318), and median length of HIV infection was 22 years (IQR 18-25). 49% had been exposed to zidovudine, stavudine or didanosine. Subjects had a median of 4 (IQR 3-6) co-morbidities and were taking a median of 9 (IQR 5-12) non-antiretroviral medications. 86% of subjects had at least one geriatric syndrome and 54% had 2 or more syndromes. 38 subjects (27%) reported at least one fall, 36 (25%) reported urinary incontinence, and 64 (45%) reported difficulty with at least 1 instrumental activity of daily living. 12 (9%) subjects met the full criteria for frailty, while 79 (56%) met criteria for pre-frailty. Every 50 unit increase in CD4 nadir (RR 0.93, 95% CI 0.88-0.99) and being employed (RR 0.57, 95% CI 0.37-0.89) were associated with a lower relative risk of the composite outcome of 2 or more geriatric syndromes.
Conclusions: In this study population over age 50, more than half of participants had 2 or more geriatric syndromes, which was associated with CD4 nadir. While the role of HIV infection in these syndromes warrants further investigation, the high frequencies of syndromes, especially difficulty with instrumental activities of daily living and pre-frailty, merit consideration of new clinical care paradigms incorporating geriatric medicine principles.