Johns Hopkins University, Baltimore, Maryland, USA.
AIDS. 2020 Jul 1;34(8):1217-1225. doi: 10.1097/QAD.0000000000002527.
Frailty is a critical aging-related syndrome marked by diminished physiologic reserve and heightened vulnerability to stress, predictive of major adverse clinical outcomes in HIV-infected and uninfected adults. Frailty is a dynamic state, yet little data exist on predictors and consequences of frailty transitions.
DESIGN/METHODS: Frailty was assessed semiannually among HIV-infected and uninfected persons with prior injection drug use using the five Fried phenotype domains. An inflammatory index score was constructed from IL-6 and soluble TNF-α receptor-1 data. Markov transition models assessed determinants of frailty transitions. Cox proportional hazards models estimated mortality risk.
Among 1353 AIDS Linked to the IntraVenous Experience participants with 9559 frailty transition assessments, 33% were HIV-infected. Younger age, higher education, employment, reduced comorbidity, HIV virologic suppression, elevated CD4 nadir (>500 cells/μl) and absence of a prior AIDS diagnosis were significantly associated with both reduced frailty progression and greater frailty recovery. Each SD decrease in inflammatory index score was associated with decreased frailty progression [odds ratio 0.78; 95% confidence interval (CI), 0.65, 0.92] and increased frailty recovery (odds ratio 1.29; 95% CI, 1.08, 1.53). Being frail at one of two consecutive visits was associated with increased mortality, compared with maintenance of a nonfrail state. Being frail at both of two consecutive visits demonstrated the highest mortality risk (hazard ratio 3.23; 95% CI, 2.1, 4.96).
Sustained, and to a lesser degree, intermittent frail states are associated with increased mortality. HIV virologic suppression with earlier antiretroviral therapy, reduced comorbidity, and reduced inflammation may prevent frailty progression and promote frailty recovery, consequently improving survival for persons aging with HIV and persons with prior injection drug use.
衰弱是一种与衰老相关的关键综合征，其特征是生理储备减少和对压力的易感性增加，可预测 HIV 感染和未感染成年人的主要不良临床结局。衰弱是一种动态状态，但关于衰弱转变的预测因素和后果的数据很少。
方法/设计：使用 Fried 五种表型领域对有既往注射吸毒史的 HIV 感染和未感染人群进行半年度衰弱评估。根据白细胞介素 6 和可溶性肿瘤坏死因子-α受体-1 数据构建炎症指数评分。马尔可夫转移模型评估衰弱转变的决定因素。Cox 比例风险模型估计死亡率风险。
在 AIDS Linked to the IntraVenous Experience 研究的 1353 名参与者中，有 9559 次衰弱转变评估，其中 33%为 HIV 感染。年龄较小、受教育程度较高、就业、合并症减少、HIV 病毒学抑制、CD4 最低点升高（>500 个细胞/μl）和无既往 AIDS 诊断与衰弱进展减少和衰弱恢复增加显著相关。炎症指数评分每降低 1 个标准差，衰弱进展的可能性就会降低[比值比 0.78；95%置信区间（CI），0.65，0.92]，衰弱恢复的可能性增加[比值比 1.29；95%CI，1.08，1.53]。与保持非衰弱状态相比，在两次连续就诊中有一次处于衰弱状态会增加死亡率。在两次连续就诊中均处于衰弱状态则显示出最高的死亡率风险（风险比 3.23；95%CI，2.1，4.96）。
持续衰弱状态，以及间歇性衰弱状态，与死亡率增加相关。通过早期抗逆转录病毒治疗实现 HIV 病毒学抑制、减少合并症和降低炎症水平，可能会阻止衰弱进展并促进衰弱恢复，从而提高 HIV 感染者和既往注射吸毒者的生存。
