Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Acquir Immune Defic Syndr. 2021 Dec 15;88(5):518-527. doi: 10.1097/QAI.0000000000002810.
People with HIV (PWH) have increased frailty risk at younger ages compared with the general population. Multimorbidity is associated with frailty, yet effects of specific comorbidities on transition to frailty in PWH are unknown.
Prospective study of 219 PWH age 45 years or older in the National NeuroAIDS Tissue Consortium.
Frailty status was categorized using Fried frailty phenotype criteria. Comorbidities [bone disease, cardiovascular disease, cerebrovascular disease, liver disease, renal disease, diabetes, chronic obstructive pulmonary disease (COPD), hypertension, obesity, cancers, neuropsychiatric conditions] were assessed from longitudinal data. Associations between baseline comorbidities and transition to frailty within 30 months were analyzed using Kaplan-Meier and Cox regression models. Grip strength was assessed using mixed-effects models.
At baseline, the median age was 61 years, 73% were male 98% were on antiretroviral therapy, 29% had ≥3 comorbidities, 27% were robust, and 73% were pre-frail. Cerebrovascular disease, diabetes, and COPD were independent predictors of transition to frailty within 30 months in models adjusted for age, sex, and multimorbidity (≥3 additional comorbidities) [hazard ratios (95% confidence intervals) 2.52 (1.29 to 4.93), 2.31 (1.12 to 4.76), and 1.82 (0.95 to 3.48), respectively]. Furthermore, cerebrovascular disease, diabetes, COPD, or liver disease co-occurring with multimorbidity was associated with substantially increased frailty hazards compared with multimorbidity alone (hazard ratios 4.75-7.46). Cerebrovascular disease was associated with decreased baseline grip strength (P = 0.0001), whereas multimorbidity, diabetes, and COPD were associated with declining grip strength (P < 0.10).
In older PWH, cerebrovascular disease, diabetes, COPD, or liver disease co-occurring with multimorbidity is associated with substantially increased risk of becoming frail within 30 months. Interventions targeting these comorbidities may ameliorate frailty and age-related functional decline in PWH.
与一般人群相比，HIV 感染者（PWH）在较年轻时就有更高的脆弱风险。合并症与脆弱相关，但特定合并症对 PWH 向脆弱过渡的影响尚不清楚。
国家神经艾滋病组织联盟中 219 名年龄在 45 岁或以上的 PWH 的前瞻性研究。
使用 Fried 脆弱表型标准对脆弱状态进行分类。从纵向数据中评估合并症[骨骼疾病、心血管疾病、脑血管疾病、肝脏疾病、肾脏疾病、糖尿病、慢性阻塞性肺疾病（COPD）、高血压、肥胖、癌症、神经精神疾病]。使用 Kaplan-Meier 和 Cox 回归模型分析基线合并症与 30 个月内向脆弱过渡之间的关系。使用混合效应模型评估握力。
在基线时，中位年龄为 61 岁，73%为男性，98%接受抗逆转录病毒治疗，29%有≥3 种合并症，27%为健壮，73%为虚弱前期。在调整年龄、性别和合并症（≥3 种额外合并症）的模型中，脑血管疾病、糖尿病和 COPD 是 30 个月内向脆弱过渡的独立预测因素[风险比（95%置信区间）为 2.52（1.29 至 4.93）、2.31（1.12 至 4.76）和 1.82（0.95 至 3.48）]。此外，与多合并症相比，脑血管疾病、糖尿病、COPD 或肝脏疾病与多合并症共存与脆弱风险显著增加相关（风险比 4.75-7.46）。脑血管疾病与基线握力降低相关（P=0.0001），而多合并症、糖尿病和 COPD 与握力下降相关（P<0.10）。
在老年 PWH 中，与多合并症共存的脑血管疾病、糖尿病、COPD 或肝脏疾病与 30 个月内虚弱的风险显著增加相关。针对这些合并症的干预措施可能会改善 PWH 的脆弱性和与年龄相关的功能下降。
