In HIV, Is Frailty Associated With Mortality?

Frailty can predict mortality and incident comorbidity independently from other risk factors, according to results of a new study.

“We found that in comparable populations of middle-aged HIV-positive and -negative participants, the frailty phenotype was strongly and consistently associated with increased risk for both all-cause mortality and incident comorbidity,” the researchers wrote. “Both effects were independent of other traditional risk factors such as age and smoking behavior.”

To conduct their study, the researchers assessed patients aged 45 years or older with (n=598) and without (n=550) HIV who were participating in the AGEhIV Cohort Study. The primary outcomes included impact of frailty on all-cause mortality over 6 years and incident comorbidity over 4 years.

Weight loss, low physical activity, exhaustion, decreased grip strength, and slow gait speed were used to assess frailty during follow-up.

Results showed that participants who were categorized as “frail” (ie, had 3 or more of the frailty assessment domains) had a significantly higher mortality rate compared with participants who were categorized as “prefrail” (ie, had 1 or 2 of the frailty assessment domains) or “robust” (ie, had zero of the frailty assessment domains).

“In fully adjusted analyses, frailty remained strongly associated with death (hazard ratio, 4.6 [95% CI, 1.7–12.5]) and incident comorbidity (odds ratio, 1.9 [95% CI, 1.1–3.1]),” the researchers wrote.

The researchers also noted that they did not observe any interactions between frailty and HIV in any of their analyses.

“[People living with HIV] are known to develop frailty and age-associated comorbidities both more frequently and at a younger age. Implementing a frailty assessment in HIV care and clinical trials could therefore be useful for improving risk stratification and clinical management and preventing adverse health outcomes in this high-risk population,” the researchers concluded.

—Amanda Balbi

Reference:

Verheij E, Kirk GD, Wit FW, et al; AGEhIV Cohort. Frailty is associated with mortality and incident comorbidity among middle-aged human immunodeficiency virus (HIV)–positive and HIV-negative participants. J Infect Dis. 2020;222(6):919-928. https://doi.org/10.1093/infdis/jiaa010