Age-related frailty and disability contribute to mortality and occur earlier in HIV+ persons, however their associations with other age-related chronic diseases remain unknown. We evaluated associations between frailty and disability and incident non-AIDS related clinical events among participants enrolled in AIDS Clinical Trials Group (ACTG) A5322.
At A5322 entry, we performed functional status assessments by measuring frailty by Fried’s criteria and disability by impairment in Instrumental Activities of Daily Living (IADL). We recorded incident cardiovascular events (CVE: coronary artery disease, myocardial infarction, angina, stroke, cardiomyopathy, peripheral arterial disease, systolic heart failure, arrhythmia, deep vein thrombosis, pulmonary embolism) and diabetes (DM). Multivariable Poisson regression assessed associations between frailty, disability, CVE and DM, as well as effect modification by demographic variables on these associations.
Among 1035 HIV+ participants, all aged ≥40 years, 81% were male, 48% were white, non-Hispanic, 29% were black, non-Hispanic, 46% were pre-frail or frail, and 17% had disability. Median age was 51 years and median duration of follow-up was 3.3 years. Forty-nine CVE were observed. Among black, non-Hispanic persons, being pre-frail/frail was associated with substantially increased risk of CVE (adjusted rate ratio [RR] 5.24, 95% C.I.=1.52,18.1) while being pre-frail/frail was not associated with CVE among persons of other race/ethnicity (white, non-Hispanic: RR=1.40, 95% C.I.=0.53,3.70; Hispanic/other: RR=1.66, 95% C.I.=0.42,6.46; interaction p-value=0.18). Disability was not associated with CVE (RR= 1.54; 95% CI =0.78,3.05). Sixty-eight incident cases of DM occurred. Disability was associated with incident DM (RR=2.03 [95% C.I.=1.17,3.54]); this association did not vary by race. Being pre-frail/frail was not associated with incident diabetes (RR= 1.45, 95% C.I.= 0.90,2.34). There was no effect modification by sex or age on associations between either disability or frailty and DM and CVE.
Within our cohort of aging HIV+ participants, frailty and disability were common and associated with significantly elevated risk for CVE and DM, respectively. While the association between frailty and CVE was only apparent among black persons, the disability/DM association existed across demographics. Routinely assessing functional status in aging HIV+ persons may optimize risk stratification for serious co-morbid conditions.