Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York.
Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
AIDS. 2022 Feb 1;36(2):237-347. doi: 10.1097/QAD.0000000000003107.
To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV.
We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS).
FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011-2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4+ cell count/μl, antiretroviral therapy, and HIV viral load.
There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) = 2.12, 95% confidence interval (CI):1.22-3.69] and MWH (aHR = 2.19, 95% CI: 1.33-3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR = 1.88, 95% CI: 1.48-2.39) and MWH (aHR = 1.59, 95% CI: 1.26-2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) = 1.43, 95% CI: 1.02-2.00] and WWH (aOR = 1.36, 95% CI: 1.08-1.71); however, high-risk FRS was not (seronegative: aOR = 1.03, 95% CI: 0.30-3.49; WWH: aOR = 0.86, 95% CI: 0.23-3.20).
Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.
了解心血管疾病（CVD）风险与男性（MWH）和感染艾滋病毒（HIV）的女性（WWH）或 HIV 高危人群之间的虚弱之间的关系。
我们考虑了 10 年的冠心病和动脉粥样硬化性 CVD 风险，通过 Framingham 风险评分（FRS，2001 年国家胆固醇教育计划成人治疗计划 III）和 Pooled Cohort Equations（PCE，2013 年美国心脏病学会/美国心脏协会），与 Multicenter AIDS Cohort Study（MACS）和 Women's Interagency HIV Study（WIHS）中的 Fried 虚弱表型（FFP）相关。
MACS 中的 FFP 是在 2004 年至 2019 年之间确定的，WIHS 是在 2005 年至 2006 年和 2011-2019 年之间确定的。FFP 评分至少有五个成分中的三个定义为虚弱。进行了重复测量逻辑回归（两个队列）和 Cox 比例风险回归（MACS），控制了教育、收入、胆固醇药物和丙型肝炎病毒血清学状态，在 MWH 和 WWH 中，还控制了 CD4+细胞计数/μl、抗逆转录病毒治疗和 HIV 病毒载量。
共纳入 5554 名参与者（1265 名 HIV 血清阴性/1396 名 MWH；768 名 HIV 血清阴性/1924 名 WWH）。在男性中，高风险的 FRS 与血清阴性和 MWH 的虚弱发生率增加相关（调整后的危险比[aHR]分别为 2.12，95%置信区间[CI]：1.22-3.69 和 2.19，95%CI：1.33-3.61）。在血清阴性和 MWH 中，高风险的 PCE 与虚弱的发生率增加也存在类似的关联（aHR 分别为 1.88，95%CI：1.48-2.39 和 1.59，95%CI：1.26-2.00）。在女性中，高风险的 PCE 与血清阴性和 WWH 的虚弱相关（调整后的比值比[aOR]分别为 1.43，95%CI：1.02-2.00 和 1.36，95%CI：1.08-1.71）；然而，高风险的 FRS 没有（血清阴性：aOR 为 1.03，95%CI：0.30-3.49；WWH：aOR 为 0.86，95%CI：0.23-3.20）。
在男性和女性中，较高的 CVD 风险与虚弱的发生率增加有关，无论 HIV 血清学状态如何。这些发现可能为虚弱的临床筛查提供信息。
