Poor Prognosis for Frail Patients with HIV

AMSTERDAM – Patients living with HIV infection had a higher risk of mortality and of developing an additional comorbidity when they registered as frail on a simple test, researchers said here.

The all-cause mortality for patients with HIV infection was 5.2 per patient-years of follow-up compared with 3.8 person-years of follow-up if the patient was not judged as frail – whether the individual did or did not have HIV (P<0.001), said Eveline Verheij, MD, a PhD candidate at the Academic Medical Center in Amsterdam.

In her oral presentation at the International AIDS Conference, Verheij said she and colleagues developed a frailty scale to determine how the condition affects mortality. Components included slow gait, low grip strength, exhaustion, low physical activity, and weight loss.

The research team devised a score in which a positive response on three or more of the criteria meant a person was "frail," and a score of 1-2 identified people who were "pre-frail," and a score of 0 was applied to individuals described as robust.

"Frailty was more prevalent among middle-age people living with HIV," Verheij said. "Frailty had a strong impact on the risk of incident comorbidity and mortality -- independent of HIV status."

Even when the investigators modeled their results with HIV-infection status, age, and the number of comorbidities, it still appeared that a high frailty score translated to a significantly increased risk of mortality.

Compared with the non-HIV patients, those who had HIV were more likely to be frail at every age stratification, and were less likely to be robust, Verheij reported. Overall, 8.5% of the HIV subjects were frail, compared with 3.4% of the patients not infected with HIV.

She said that in considering just HIV-infected persons, univariate analysis helped when the model was adjusted for age, HIV risk group, ethnicity, and education, but the effect was attenuated by including differences in waist-to-hip measurements. And the results were no longer significant if the number of comorbidities was included or if the model was adjusted for depressive symptomatology.

The multi-stage study enrolled 550 HIV-negative persons with a mean age of 52.1 -- 70.2% of whom were men who had sex with men, and 61.1% had no other comorbidities. These individuals were compared with 596 others who were HIV-positive. Mean age for them was approximately 52.7; 75.8% were men who had sex with men, and about 48.3% were free of other comorbidities.

The HIV cohort had been diagnosed with infection for about 12 years, and 95.8% were on antiretroviral therapy at the time of enrollment in the study. About one-third of the group had a history of an AIDS-defining event.

The co-chair of the session at which the data were presented, Cissy Kityo Mutuluuza, MD, deputy director of the Joint Clinical Research Center, a venture of the Uganda Ministry of Health and Makaree University in Kampala, told MedPage Today: "Frailty could be used as a screening tool so you can make long-term judgments among patients you are putting on long-term medications. We should be screening people for frailty."

Also commenting, Priscilla Hsue, MD, of the University of California San Francisco, said that the study was done with a large group of patients, one of the first studies to link frailty to mortality. "It makes sense," she said. "If you can't do hand grips, you probably have a lot of problems."

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