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  13th International Workshop on
HIV and Aging
13-14 October 2022

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Polypharmacy, Anxiety, Low Cognitive
Score Tied to Frailty With HIV

  International Workshop on HIV and Aging, October 13-14, 2022
By Mark Mascolini for NATAP and Virology Education
Despite HIV control with antiretroviral therapy, most of 165 people with HIV had some signals of clinical frailty, according to a University of Maryland study [1]. Only one quarter met Fried frailty phenotype criteria for nonfrailty [2]. Anxiety, taking more than 5 non-HIV drugs, and low cognitive score on a standard test independently predicted frailty in this largely African-American Baltimore group.
Clinically defined frailty can affect people with HIV up to two decades earlier than the general population, noted University of Maryland researchers who conducted this study. Around age 40, frailty prevalence may range from 5% to 30% in HIV populations, they added. This study used two standard frailty measures-Fried frailty phenotype (FP) and the Short Performance Physical Battery (SPPB)-in a comprehensive geriatric screening model at a Baltimore clinic of the University of Maryland.
Researchers invited clinic attendees 50 or older with HIV infection to participate. Trained clinic staff assessed FP and SBBP in all participants. An FP score of 0 meant nonfrail (robust), 1 to 2 out of 5 meant prefrail, and 3 to 5 meant frail. An FPPB score at or below 9 (out of 12) signaled a positive screen for potential frailty.
Researchers enrolled 184 adults from November 2019 to February 2022, and 165 completed both the FP and the SBBP tests. Almost all participants, 94%, were black, 56% were men, and median age stood at 59 (interquartile range 55 to 63). Three quarters of participants, 78%, had an undetectable HIV viral load, and median CD4 count measured 606.
Among the 165 people who completed both assessments, only 27% were robust according to FP measures, while 62% were prefrail and 11% frail. Most to least frequent FP categories were weakness in 50.9%, slow walk speed in 31%, excessive weight loss in 20.1%, low physical activity in 17%, and exhaustion in 4.8%.
In these 165 participants, about 60% had a low SPPB score, about 30% had an intermediate score, and under 10% were normal on SPPB.
All participants frail by FP criteria had an SPPB score at or below 9, yielding a sensitivity of 100% for predicting FP frailty by low SPPB. But specificity for this association was only 41%, and it had a positive predictive value of only 17%.
An analysis not adjusted for other variables identified four predictors of frailty: polypharmacy, meaning more than 5 non-HIV pills daily, Montreal Cognitive Assessment (MoCA) score at or below 18, Patient Health Questionnaire (PHQ-9) depression score at or above 5, and Generalized Anxiety Disorder (GAD-7) score 5 to 9 or 10 or higher. Three variables remained independent predictors of frailty in multivariate analysis:
- Polypharmacy: Odds ratio (OR) 7.8, P = 0.005
- Generalized anxiety disorder-7 of 10 or higher: OR 16.4, P = 0.03
- Montreal Cognitive Assessment score at or below 18: OR 24.3, P = 0.03
The University of Maryland team suggested that promoting physical function and weight loss, controlling polypharmacy, and addressing anxiety and cognition “may be strategies that could mitigate and prevent frailty” in aging people with HIV.
1. Eke U, Gruber-Baldini A, Mohanty K, et al. Frailty and physical performance assessments as part of a comprehensive geriatric care model in an urban HIV clinic. International Workshop on HIV and Aging, October 13-14, 2022d. Abstract 11.
2. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-156. doi: 10.1093/gerona/56.3.m146. https://academic.oup.com/biomedgerontology/article/56/3/M146/545770?login=false