Effect of HIV-infection and cumulative viral load on age-related decline in grip strength

Abstract

Objective Grip strength predicts functional decline and death, and is regarded as a biomarker of biological aging. The primary objective of this manuscript was to assess differences in the rate of decline in grip strength in persons aging with and without HIV. Design Grip strength was assessed in 1,552 (716 HIV+ and 836 HIV−) men ≥ 50 years participating in the Multicenter AIDS Cohort Study between 2007 and 2014. Methods Grip strength decline was modeled longitudinally, adjusting for serostatus, demographics, comorbidities, and conditions. In HIV-specific models, coefficients were included for cumulative viral load and history of AIDS. Results Grip strength at age 50 averaged 37.9 kg and 38.2 kg for HIV+ and HIV− men, respectively (p = 0.70). In fully adjusted models, grip strength declined 0.33 kg/yr in HIV− men (p <0.001) and 0.42 kg/yr in HIV+ men (p = 0.01). In HIV-stratified models, higher cumulative viral load indicated greater strength decline (−0.884 kg for 3.1 – 4.0 log10 copies-years/mL and −1.077 kg for ≥ 4.1 log10 copies-years/mL) relative to men with consistently low viral load (≤ 3.0 log10 copies-years/mL). Adjusted Cox proportional hazard models revealed a 70% greater risk of clinically weak grip strength in HIV+ men (aHR 1.70; 95% CI, 1.22 – 2.40). Conclusions Grip strength decline is accelerated in HIV-infected men, which may contribute to decreased life expectancy and lower quality of life with aging. Greater cumulative viral load exposure appears to be an important driver of this decline and underscores the importance of early initiation of therapy.

Disease drivers of aging

“…Both ART and HIV were found to have toxic effects on the muscle, with many of the older nucleoside reverse transcriptase inhibitor (NRTI) therapies later implicated in mitochondrial toxicity . HIV‐infected adults also have been shown to have gene expression patterns consistent with fibrosis and collagen deposition and to have greater fatty infiltration of the muscle and decreased strength with aging compared with HIV‐uninfected controls …”

HIV and Aging – Perhaps Not as Dramatic as We Feared?

“…However, HIV-positive men had a more rapid decline in grip strength and clinical weakness occurred earlier. Factors contributing to frailty in HIV may include older age, lower BMI, diabetes mellitus, chronic kidney disease, peripheral neuropathy, and higher cumulative HIV viral load correlated with a greater longitudinal decline in grip strength [54]. …”

Geriatric syndromes

“…In the French Agency for AIDS and Hepatitis Research (ANRS) CO3 Aquitaine Cohort (n=324), 53% of subjects performed poorly in the five-times sit-to-stand test (5STS), a test of lower limb muscle performance [37] ; a longer duration of HIV diagnosis, but not of use of cART, was associated with poorer performance on the 5STS. Recent findings in the Multicenter AIDS Cohort Study (MACS) have suggested that both strength and gait speed decline faster after age 50 to 60 among HIV-infected compared to HIV- uninfected men, adjusted for viral suppression and other HIV-related factors, indicating an accelerated functional decline even with treated HIV infection [38, 39] . Importantly, loss of muscle strength and function is a major component of frailty, and is typically clinically apparent before loss of muscle mass [17] .…”