J Acquir Immune Defic Syndr. 2012 Sep 26. [Epub ahead of print]
Frailty in HIV-infected adults in South Africa.
Source
1International Centre for Eye Health, Dept of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. 2MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK 3Dept. of Ophthalmology, Faculty of Health Sciences, University of Cape Town, H53 Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, SouthAfrica. 4Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa. 5Dept. of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Abstract
OBJECTIVES:
Some evidence suggests that HIV infection is associated with premature frailty -a syndrome typically viewed as being related to ageing. We determined the prevalence and predictors of frailty in a population of HIV-infected individuals in South Africa.
DESIGN:
Case-control study of 504 adults over the age of 30 years, composed of 248 HIV-infected adults and 256 age- and gender- frequency-matched HIV-seronegative individuals.
METHODS:
Frailty was defined by standardized assessment comprised of ≥3 of: weight loss, low physical activity, exhaustion, weak grip strength and slow walking time. Independent predictors of frailty were evaluated using multivariable logistic regression.
RESULTS:
The mean ages of the HIV-infected and HIV-seronegative groups were 41.1±7.9 years and 42.6±9.6 years respectively. Of the HIV-infected adults, 87.1% were receiving antiretroviral treatment (ART) (median duration, 58 months), their median CD4 count was 468 cells/μL (IQR:325-607 cells/μL) and 84.3% had undetectable plasma viral load. HIV-infected adults were more likely to be frail than HIV-seronegative individuals (19.4% vs.13.3%;p=0.07), and this association persisted after adjustment for confounding variables (adjusted odds ratio [OR] 2.14; 95% confidence interval [95%CI]: 1.16-3.92, p=0.01). Among HIV-infected individuals, older age was a strong predictor of frailty, especially among women (women: OR=2.55 per 10-year age increase; men: OR=1.29 per 10 year age increase, p-interaction=0.01). Lower current CD4 count (<500 cells/μL) was also independently associated with frailty (OR=2.84;95%CI:1.02-7.92, p=0.04).
CONCLUSION:
HIV infection is associated with premature development of frailty, especially in women. Since higher CD4 counts were associated with lower risk of frailty, earlier initiation of ART may be protective.
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