Frailty is a critical aging-related syndrome marked by diminished physiologic reserve and heightened vulnerability to stress, predictive of major adverse clinical outcomes in older adults. We have previously demonstrated that frailty burden is heightened with HIV infection and strongly associated with increased hospitalization and death among persons aging with HIV. Though frailty is considered dynamic, little data exist on the factors determining transitions between frailty states among HIV-infected or uninfected adults.
Frailty was assessed semiannually among HIV-infected and uninfected persons with a history of injection drug use in the AIDS Linked to the IntraVenous Experience (ALIVE) cohort from 2005 through 2013 based on the 5 Fried physical frailty phenotype domains – weight loss, low physical activity, exhaustion, decreased grip strength, and slow gait speed. An inflammatory index score was constructed from serum measures of interleukin-6 (IL-6) and soluble tumor necrosis factor-α receptor-1 (sTNFR1). Markov transition models were used to assess the relationship of sociodemographics, chronic comorbid disease, HIV clinical factors and inflammation to transitions between frailty states.
Among 1353 ALIVE participants with 9559 frailty transitions, 33% were HIV positive. Younger age, higher educational attainment, employment, and reduced chronic disease comorbidity were significantly associated with reduced frailty progression and greater frailty recovery. Adjusting for sociodemographics, substance use and comorbidity, HIV virologic suppression, elevated CD4 nadir (>500) and absence of a prior AIDS diagnosis were all significantly associated with reduced frailty progression and improved frailty recovery. Likelihood of frailty transition for these less advanced HIV disease states was similar to HIV seronegative status. Adjusting for sociodemographics, comorbidity, substance use and HIV disease stage, for each standard deviation decrease in inflammatory index score, there was a 22% decreased likelihood of frailty progression (aOR 0.78; 95% CI, 0.65, 0.92) and 29% increased likelihood of frailty recovery (aOR 1.29; 95% CI, 1.08, 1.53).
HIV virologic suppression with early ART, improved socioeconomic environment, prevention and reduction of chronic disease comorbidity, and reduced inflammation may reduce frailty progression and promote frailty recovery; these interventions could reduce hospitalization and improve survival for persons aging with HIV.