Frailty in medically complex individuals with chronic HIV

Susan Morgello, Gary Gensler, Seth Sherman, Ronald J. Ellis, Benjamin Gelman, Dennis L. Kolson, Scott L. Letendre, Jessica Robinson-Papp, Leah H. Rubin, Elyse Singer, Miguel Valdes-Sueiras

Research output: Contribution to journalArticle

Abstract

Objectives:Multimorbidity and frailty are consequences of aging with HIV, yet not everyone with medical disease is frail. Our objective was to identify factors associated with frailty in a multimorbid HIV-infected cohort.Design:Analysis of a prospective, observational, longitudinal cohort.Methods:Three hundred and thirty-two participants in the medically advanced National NeuroAIDS Tissue Consortium (NNTC) study were categorized as frail, prefrail, or robust with the Fried Frailty Index. A series of logistic regression analyses (first univariate, then multivariable) were conducted to determine whether medical comorbidities, immunologic and virologic parameters, and/or neuropsychiatric variables predicted increased odds of frailty.Results:The mean number of medical comorbidities per participant was 2.7, mean CD4+ T-cell count was 530 cells/μl, and 77% had undetectable HIV RNA in blood. Twenty-two percent were frail, 55% prefrail, and 23% robust. Significant predictors of frailty in multivariable analysis were cognitive diagnosis rendered by Frascati criteria, depressive symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and sex. Men were less likely to be frail than women. Higher odds of frailty were seen with: Symptomatic, but not asymptomatic, cognitive impairment (compared with cognitive normals); more depressive symptoms; diabetes mellitus; and COPD.Conclusion:Neuropsychiatric illness increased odds of being frail on a predominantly physical/motoric measure, but only when symptomatic. Lack of association with asymptomatic impairment may reflect the importance of functional limitation to frailty, or possibly a unique resilience phenotype. Understanding why sex and symptomatic neuropsychiatric illness are associated with frailty will be important in managing HIV-associated morbidity in aging populations.

Original languageEnglish (US)
Pages (from-to)1603-1611
Number of pages9
JournalAIDS
Volume33
Issue number10
DOIs
StatePublished - Aug 1 2019

Fingerprint

HIV
Comorbidity
Chronic Obstructive Pulmonary Disease
Diabetes Mellitus
Depression
CD4 Lymphocyte Count
Logistic Models
Regression Analysis
RNA
Morbidity
T-Lymphocytes
Phenotype
Population
Cognitive Dysfunction

Keywords

  • cognitive impairment
  • depression
  • diabetes
  • frailty
  • HIV
  • pulmonary disease
  • women

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Morgello, S., Gensler, G., Sherman, S., Ellis, R. J., Gelman, B., Kolson, D. L., ... Valdes-Sueiras, M. (2019). Frailty in medically complex individuals with chronic HIV. AIDS, 33(10), 1603-1611. https://doi.org/10.1097/QAD.0000000000002250

Frailty in medically complex individuals with chronic HIV. / Morgello, Susan; Gensler, Gary; Sherman, Seth; Ellis, Ronald J.; Gelman, Benjamin; Kolson, Dennis L.; Letendre, Scott L.; Robinson-Papp, Jessica; Rubin, Leah H.; Singer, Elyse; Valdes-Sueiras, Miguel.

In: AIDS, Vol. 33, No. 10, 01.08.2019, p. 1603-1611.

Research output: Contribution to journalArticle

Morgello, S, Gensler, G, Sherman, S, Ellis, RJ, Gelman, B, Kolson, DL, Letendre, SL, Robinson-Papp, J, Rubin, LH, Singer, E & Valdes-Sueiras, M 2019, 'Frailty in medically complex individuals with chronic HIV', AIDS, vol. 33, no. 10, pp. 1603-1611. https://doi.org/10.1097/QAD.0000000000002250
Morgello S, Gensler G, Sherman S, Ellis RJ, Gelman B, Kolson DL et al. Frailty in medically complex individuals with chronic HIV. AIDS. 2019 Aug 1;33(10):1603-1611. https://doi.org/10.1097/QAD.0000000000002250
Morgello, Susan ; Gensler, Gary ; Sherman, Seth ; Ellis, Ronald J. ; Gelman, Benjamin ; Kolson, Dennis L. ; Letendre, Scott L. ; Robinson-Papp, Jessica ; Rubin, Leah H. ; Singer, Elyse ; Valdes-Sueiras, Miguel. / Frailty in medically complex individuals with chronic HIV. In: AIDS. 2019 ; Vol. 33, No. 10. pp. 1603-1611.
@article{29dae4af8547471c955976dc386799dd,
title = "Frailty in medically complex individuals with chronic HIV",
abstract = "Objectives:Multimorbidity and frailty are consequences of aging with HIV, yet not everyone with medical disease is frail. Our objective was to identify factors associated with frailty in a multimorbid HIV-infected cohort.Design:Analysis of a prospective, observational, longitudinal cohort.Methods:Three hundred and thirty-two participants in the medically advanced National NeuroAIDS Tissue Consortium (NNTC) study were categorized as frail, prefrail, or robust with the Fried Frailty Index. A series of logistic regression analyses (first univariate, then multivariable) were conducted to determine whether medical comorbidities, immunologic and virologic parameters, and/or neuropsychiatric variables predicted increased odds of frailty.Results:The mean number of medical comorbidities per participant was 2.7, mean CD4+ T-cell count was 530 cells/μl, and 77{\%} had undetectable HIV RNA in blood. Twenty-two percent were frail, 55{\%} prefrail, and 23{\%} robust. Significant predictors of frailty in multivariable analysis were cognitive diagnosis rendered by Frascati criteria, depressive symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and sex. Men were less likely to be frail than women. Higher odds of frailty were seen with: Symptomatic, but not asymptomatic, cognitive impairment (compared with cognitive normals); more depressive symptoms; diabetes mellitus; and COPD.Conclusion:Neuropsychiatric illness increased odds of being frail on a predominantly physical/motoric measure, but only when symptomatic. Lack of association with asymptomatic impairment may reflect the importance of functional limitation to frailty, or possibly a unique resilience phenotype. Understanding why sex and symptomatic neuropsychiatric illness are associated with frailty will be important in managing HIV-associated morbidity in aging populations.",
keywords = "cognitive impairment, depression, diabetes, frailty, HIV, pulmonary disease, women",
author = "Susan Morgello and Gary Gensler and Seth Sherman and Ellis, {Ronald J.} and Benjamin Gelman and Kolson, {Dennis L.} and Letendre, {Scott L.} and Jessica Robinson-Papp and Rubin, {Leah H.} and Elyse Singer and Miguel Valdes-Sueiras",
year = "2019",
month = "8",
day = "1",
doi = "10.1097/QAD.0000000000002250",
language = "English (US)",
volume = "33",
pages = "1603--1611",
journal = "AIDS",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Frailty in medically complex individuals with chronic HIV

AU - Morgello, Susan

AU - Gensler, Gary

AU - Sherman, Seth

AU - Ellis, Ronald J.

AU - Gelman, Benjamin

AU - Kolson, Dennis L.

AU - Letendre, Scott L.

AU - Robinson-Papp, Jessica

AU - Rubin, Leah H.

AU - Singer, Elyse

AU - Valdes-Sueiras, Miguel

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Objectives:Multimorbidity and frailty are consequences of aging with HIV, yet not everyone with medical disease is frail. Our objective was to identify factors associated with frailty in a multimorbid HIV-infected cohort.Design:Analysis of a prospective, observational, longitudinal cohort.Methods:Three hundred and thirty-two participants in the medically advanced National NeuroAIDS Tissue Consortium (NNTC) study were categorized as frail, prefrail, or robust with the Fried Frailty Index. A series of logistic regression analyses (first univariate, then multivariable) were conducted to determine whether medical comorbidities, immunologic and virologic parameters, and/or neuropsychiatric variables predicted increased odds of frailty.Results:The mean number of medical comorbidities per participant was 2.7, mean CD4+ T-cell count was 530 cells/μl, and 77% had undetectable HIV RNA in blood. Twenty-two percent were frail, 55% prefrail, and 23% robust. Significant predictors of frailty in multivariable analysis were cognitive diagnosis rendered by Frascati criteria, depressive symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and sex. Men were less likely to be frail than women. Higher odds of frailty were seen with: Symptomatic, but not asymptomatic, cognitive impairment (compared with cognitive normals); more depressive symptoms; diabetes mellitus; and COPD.Conclusion:Neuropsychiatric illness increased odds of being frail on a predominantly physical/motoric measure, but only when symptomatic. Lack of association with asymptomatic impairment may reflect the importance of functional limitation to frailty, or possibly a unique resilience phenotype. Understanding why sex and symptomatic neuropsychiatric illness are associated with frailty will be important in managing HIV-associated morbidity in aging populations.

AB - Objectives:Multimorbidity and frailty are consequences of aging with HIV, yet not everyone with medical disease is frail. Our objective was to identify factors associated with frailty in a multimorbid HIV-infected cohort.Design:Analysis of a prospective, observational, longitudinal cohort.Methods:Three hundred and thirty-two participants in the medically advanced National NeuroAIDS Tissue Consortium (NNTC) study were categorized as frail, prefrail, or robust with the Fried Frailty Index. A series of logistic regression analyses (first univariate, then multivariable) were conducted to determine whether medical comorbidities, immunologic and virologic parameters, and/or neuropsychiatric variables predicted increased odds of frailty.Results:The mean number of medical comorbidities per participant was 2.7, mean CD4+ T-cell count was 530 cells/μl, and 77% had undetectable HIV RNA in blood. Twenty-two percent were frail, 55% prefrail, and 23% robust. Significant predictors of frailty in multivariable analysis were cognitive diagnosis rendered by Frascati criteria, depressive symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and sex. Men were less likely to be frail than women. Higher odds of frailty were seen with: Symptomatic, but not asymptomatic, cognitive impairment (compared with cognitive normals); more depressive symptoms; diabetes mellitus; and COPD.Conclusion:Neuropsychiatric illness increased odds of being frail on a predominantly physical/motoric measure, but only when symptomatic. Lack of association with asymptomatic impairment may reflect the importance of functional limitation to frailty, or possibly a unique resilience phenotype. Understanding why sex and symptomatic neuropsychiatric illness are associated with frailty will be important in managing HIV-associated morbidity in aging populations.

KW - cognitive impairment

KW - depression

KW - diabetes

KW - frailty

KW - HIV

KW - pulmonary disease

KW - women

UR - http://www.scopus.com/inward/record.url?scp=85069883025&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069883025&partnerID=8YFLogxK

U2 - 10.1097/QAD.0000000000002250

DO - 10.1097/QAD.0000000000002250

M3 - Article

VL - 33

SP - 1603

EP - 1611

JO - AIDS

JF - AIDS

SN - 0269-9370

IS - 10

ER -