The relationship of physical performance with HIV disease and mortality

Abstract

Objective To evaluate whether HIV infection was associated with reduced physical performance, and to examine if reduced physical performance predicted mortality in our aging cohort of HIV-infected and HIV-uninfected persons. Design Prospective, observational cohort of current and former injection drug users in the AIDS Linked to the IntraVenous Experience study in Baltimore, Maryland, USA. Methods The Short Physical Performance Battery (SPPB) was used as an objective measure of physical performance and measured semiannually along with behavioral and demographic data. Correlates of reduced physical performance (SPPB score ≤10) were identified and the relationship between reduced physical performance, HIV infection and mortality was analyzed by Cox regression. Results Among 12 270 person-visits contributed by 1627 participants, the median age was 51, 30.3% were HIV-infected and 32.6% had an SPPB score 10 or less. In multivariable models, HIV infection was independently associated with 30% increased odds of reduced physical performance [odds ratio 1.30; 95% confidence interval (CI):1.12–1.52]. Reduced physical performance predicted mortality in a dose-response manner and within all HIV disease strata. Whereas reduced physical performance alone (hazard ratio 2.52, 95% CI: 1.59–4.00) and HIV infection alone (hazard ratio 2.78, 95% CI: 1.70–4.54) increased mortality, HIV-infected participants with reduced physical performance had a six-fold increased mortality risk (hazard ratio 6.03, 95% CI: 3.80–10.0) compared with HIV-uninfected participants with higher physical performance. Conclusion HIV infection was independently associated with reduced physical performance. HIV and reduced physical performance have independent and joint effects on mortality. Physical performance measurement may be an important research and clinical tool to predict adverse outcomes among aging HIV-infected persons.

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

“…A typical 65-year-old lives with two or more chronic conditions[23]. The addition of chronic HIV infection to this disease burden adds another layer of complexity to an aging system, which may hasten the onset of functional decline, aggravating the risk of future disability and death[2, 3]. Further, our results suggest a strong psychosocial component to rate of decline in grip strength, as demonstrated by the significant contributions of race and education.…”

“…Although a link between reduced functional performance and HIV infection has been hypothesized, the majority of previous research has focused on the syndrome of frailty[25, 26], aerobic capacity[27], or composite measures of performance[3]. Moreover, previous research limited to differences in grip strength by HIV serostatus has been cross sectional, focused on participants with lipodystrophy, or largely inconclusive[12, 13, 28], leaving the possibility of differences in the rate of strength decline undefined.…”

Geriatric Assessments and Association With VACS Index Among HIV-Infected Older Adults in San Francisco

“…Another possible limitation is the use of self-reported functional status, as self-report of functional status may be predictive of outcomes such as mortality in HIV-negative populations, 37 but only objective measures of physical function have been studied with outcomes in HIV-positive populations. 10,11 Although we included adherence to antiretroviral medications and the association between polypharmacy and age, we did not examine adherence to other chronic medications or perform a more detailed evaluation of types of other chronic medications, both of which are important issue for the aging HIV-positive population. While our findings add support to current guidelines recommending integration of geriatric and HIV medicine principles, 38 next steps should include developing interventions to address the complex medical needs we found and understanding if the same interventions designed to work in older HIV negative populations have utility for the aging HIV population.…”

“…10-12 Utilizing geriatric assessments in combination with traditional HIV assessments in HIV care settings could help providers address the medical complexity experienced by older HIV-infected adults and identify the most vulnerable patients in need of additional intervention. Other tools such as the Veterans Aging Cohort Study (VACS) Index, a prognostic tool based on both HIV and comorbid condition markers, can also be used to identify adults at the highest risk of morbidity and mortality.…”

Understanding Frailty, Aging, and Inflammation in HIV Infection

“…This study found that expression of the Fried FP did indeed predict mortality in this cohort of IDUs. Recently, another study from the ALIVE cohort found that poor physical function, as assessed by the short physical performance battery (SPPB) was also an independent predictor of mortality (42). In addition, data from the Veterans Aging Cohort Study (VACS) showed that an adapted frailty-related phenotype was predictive for hospitalization and mortality in aging HIV-infected veterans (6).…”