Physical function, grip strength and frailty in people living with HIV in sub‐Saharan Africa: systematic review

Abstract

Objective To present the current knowledge on physical function, grip strength and frailty in HIV-infected patients living in sub-Saharan Africa, where the phenomenon is largely underestimated. Methods A systematic search was conducted on Medline, Scopus and African Index Medicus. We reviewed articles on sub-Saharan African people living with HIV (PLHIV) >18 years old, published until November 2016. Results Of 537 articles, 13 were conducted in six African countries and included in this review. Five articles reported information on functional limitation and one on disability. Two of these 5 articles reported functional limitation (low gait speed) in PLHIV. Disability was observed in 27% and 3% of PLHIV living in rural and urban places, respectively. Two of three studies reporting grip strength reported lower grip strength (nearly 4 kg) in PLHIV in comparison to uninfected patients. One study reported that PLHIV were more likely to be frail than HIV-uninfected individuals (19.4% vs.13.3%) whereas another reported no statistical difference. Conclusion Decline in physical function, grip strength and frailty are now part of the burden of PLHIV living in SSA countries but current data are insufficient to characterize the real public health dimension of these impairments. Further studies are needed to depict this major public health challenge. As this is likely to contribute to a significant burden on the African healthcare systems and human resources in the near future, a holistic care approach should be developed to inform guidelines.

Pathogenesis of HIV-Related Lung Disease: Immunity, Infection, and Inflammation

“…Despite these factors, survival has improved with expansion of free ART to treat millions of PLWH in LMIC. However, as these individuals age, they are at higher risk for noncommunicable diseases compared with HIV-negative individuals (206,212), and the prevalence of chronic comorbidities and disability in PLWH in LMIC is increasing dramatically (28,271).…”

Sarcopenia in people living with the Human Immunodeficiency Virus: a systematic review and meta-analysis

“…In this review, we selected original sarcopenia studies which adopted one of the above-mentioned sarcopenia operational definitions. We are aware that there are a large body of literature that has assessed and described the characteristics of muscle mass or function in PLHIV, variables which were usually impaired compared with people without HIV [7,26,27]. But because these variables have been assessed separately, or studies did not employ a cut point to classify subjects with low or normal range, these studies were not included in this review.…”

“…Among these causes and mechanisms, one factor that may exert influence on sarcopenia prevalence in lower resource settings is malnutrition, given that a higher BMI appears to protect against the development of sarcopenia in PLHIV. There are not studies of sarcopenia (as it is current defined) that have been conducted in lowincome countries, but studies investigating muscle function in low-income African countries have demonstrated a strong link between muscle strength and nutritional status of PLHIV [27,65].…”

Nutritional status is the major factor affecting grip strength of African HIV patients before and during antiretroviral treatment

“…An index of frailty, originally designed to assess older adults, comprising unintentional weight loss, slow walking speed, low grip strength, self‐reported exhaustion and low energy expenditure , predicts morbidity and mortality among American and European HIV patients . The limited data on frailty and grip strength among HIV‐infected persons in sub‐Saharan Africa have recently been reviewed . The few prior studies have found that HIV infection is a risk factor for frailty among South Africans and for low grip strength among Ethiopian adults .…”