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GLYCEMIC CONTROL AND COGNITION ARE INDEPENDENTLY ASSOCIATED WITH GAIT SPEED DECLINE
Mary Clare Masters1, Jeremiah Perez2, Katherine Tassiopoulos2, Adriana Andrade3, Ronald J. Ellis4, Jingyan Yang5, Todd T. Brown6, Frank J. Palella1, Kristine M. Erlandson7
1Northwestern University, Chicago, IL, USA,2Harvard University, Boston, MA, USA,3DAIDS, NIAID, Rockville, MD, USA,4University of California San Diego, San Diego, CA, USA,5Columbia University, New York, NY, USA,6Johns Hopkins University, Baltimore, MD, USA,7University of Colorado, Aurora, CO, USA
Neurocognitive impairment (NCI) and impaired glucose metabolism have been associated with decline in gait speed in the general population. Gait speed declines more in people living with HIV (PLWH) compared to uninfected persons, but factors related to this functional outcome are limited to a single cohort of men.
AIDS Clinical Trials Group (ACTG) A5322 (HAILO) is an observational cohort study of PLWH ≥ 40 years old that includes semi-annual laboratory tests and annual cognitive and gait speed assessments. Slowness was defined as gait speed of >4 seconds on 4-m walk. Participants who developed slowness during the first 3 years were compared to persons who maintained normal speed. We used multivariable logistic regression to assess associations between development of slowness and baseline covariates including age, sex, race, alcohol use, BMI, waist circumference, nadir CD4, history of AIDS defining illness, hemoglobin A1C (HbA1C), and NCI (≥1 z-score ≥2 SD below 0 or ≥2 z-scores ≥1 SD below 0 on Trailmaking A and B and the Wechsler Adult Intelligence Scale-Revised Digit Symbol tests).
Of 929 participants, 81% were male, 31% Black, and 20% Hispanic. Median age was 51 years (IQR 46-56). Most individuals (91.9%) had undetectable plasma HIV RNA (VL <50 copies/mL) with median CD4 count 631 cells/mm³ (IQR 458-840) at study entry. At study entry, 7% of participants had slow gait, 16% had NCI, 12% had diabetes. Over 3 years, 6% of participants developed a slow gait and 87% maintained a normal gait. In multivariable models, HbA1C percentage, per 1% change (OR 1.40; 95% CI=1.06, 1.85; p=0.019), NCI (OR 3.38; 95% CI=1.53, 7.46; p=0.003), and black vs white race (OR 2.34; 95% CI=1.03, 5.29; p=0.042) at entry were significantly associated with increasing prevalence of slowness compared to those maintaining normal gait speed.
The association between baseline hemoglobin A1C and development of slow gait speed highlights an intervenable target to prevent progression of physical function limitations. Additionally, the presence of NCI among PLWH should prompt screening for and early intervention to avert declines in physical function.