Construct validation of a Frailty Index, an HIV Index and a Protective Index from a clinical HIV database

Abstract

BackgroundStandard care for HIV clinical practice has started focusing on age-related problems, but despite this recent change physicians involved in HIV care do not often screen HIV patients for frailty. Our aim was to construct three indexes from an HIV clinical database (i.e. Frailty Index, (FI), HIV Index, (HIVI), and Protective Index (PI)) and to assess levels of frailty, HIV severity and demographic and protective lifestyle factors among HIV patients.Methods and findingsWe included data from 1612 patients who attended an Italian HIV clinic between September 2016 and December2017 (mean±SD age: 53.1±8 years, 73.9% men).We used 92 routine variables collected by physicians and other health care professionals to construct three indexes: a 72-item FI (biometric, psychiatric, blood test, daily life activities, geriatric syndromes and nutrition data), a 10-item HIVI (immunological, viral and therapeutics) and a 10-item PI (income, education, social engagement, and lifestyle habits data)(the lower the FI and HIVI scores, and the higher the PI scores, the lower the risk for participants).The FI, HIVI and PI scores were 0.19±0.08, 0.48±0.17 and 0.62±0.13, respectively. Men had higher FI (0.19±0.08 vs 0.18±0.08; p = 0.010) and lower HIVI (0.47±0.18 vs 0.50±0.15; p = 0.038) scores than women. FI and HIVI scores both increased 1.9% per year of age (p < 0.001), whereas the PI decreased 0.2% per year (p<0.050). In addition, the FI score increased 1.6% and the PI score decreased 0.5% per year of HIV infection (p < 0.001).ConclusionIt is feasible to assess levels of frailty, HIV severity and protective lifestyle factors in HIV patients using data from a clinical database. Frailty levels are high among HIV patients and even higher among older patients and those with a long duration of HIV. Future studies need to examine the ability of the three indices to predict adverse health outcomes such as hospitalization and mortality.

The Interplay Between Frailty and Intrinsic Capacity in Aging and HIV Infection

“…Importantly, the specific deficits included in the index can vary according to the available data. 24 Thus, the construct of the frailty phenotype hypothesizes an underlying biological syndrome, while the frailty index describes frailty as a nonspecific age-associated vulnerability ( Table 1). 25 In one comparative study from our group, conducted at Modena HIV Metabolic clinic, frailty phenotype and the frailty index displayed similar characteristics, but the frailty index had a stronger association with age, nadir CD4, comorbidities, falls, and disability in comparison to frailty phenotype.…”

“…A similar approach could be used in HIV setting, taking into consideration specific HIV variables that may contribute the risk for frailty, as well as social protective factors, which may compensate frailty risks. 24 Integrating frailty assessment in clinical practice may also be crucial for the development of interventions against agerelated conditions, including disability and falls in OALWH. 26 In HIV setting, few studies have been conducted to reproduce the interventions of proven efficacy in reverting frailty in the general population.…”

Air Pollutants and Frailty in Older Adults: A Geriatrician’s Perspective

“…Similar to other several diseases, a unique evaluation and risk stratification system specialized for older populations are required. [14][15][16] With these concerns, our researchers believe that frailty, a valuable measure of the health status of older individuals, might be the most suitable marker for measuring the effects of air pollutants in older populations. 17,18) This measure encompasses all age-related symptoms and disorders such as dementia, sarcopenia, insomnia, and falls, which can be used to estimate the possible effects.…”

“…2) Therefore, rather than the conventional frailty index, a targeted concept and definition of frailty, namely an "air-pollutant frailty index" that reflects both the specificity of the aging physiology and the conventional known health effects of air pollutant exposure, should be developed. 16) As with human immunodeficiency virus, 14) myelodysplastic syndrome, 19) and systemic lupus erythematosus, 15) this concept of a disease-specific frailty index is also likely to be effective in vulnerable young populations. This frailty concept will serve as a compass for future fine dust studies in older adults.…”

“…Similar to other several diseases, a unique evaluation and risk stratification system specialized for older populations are required. 14 - 16 )…”