HIV This Week

Desquilbet L, Jacobson LP, Fried LP, Phair JP, Jamieson BD, Holloway M, Margolick JB: Multicenter AIDS Cohort Study. HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty J Gerontol A Biol Sci Med Sci. 2007;62(11):1279-86

Older healthy and adults living with HIV exhibit physiological similarities. Frailty is a clinical syndrome associated with aging that identifies a subset of older adults at high risk of mortality and other outcomes. Desquilbet and colleagues investigated whether HIV infection increases the prevalence of a frailty-related phenotype that approximates a clinical definition of frailty. The authors first defined the frailty-related phenotype and assessed its prevalence among HIV-uninfected men followed in the Multicenter AIDS Cohort Study (MACS) between 1994 and 2004. Using repeated measurements logistic regression models, they then assessed the association between frailty-related phenotype and HIV infection before the era of highly active antiretroviral therapies, adjusting for covariates among HIV-uninfected (N = 1905) and incident HIV infections (N = 245). HIV infection was strongly associated with frailty-related phenotype prevalence. Compared to men without HIV of similar age, ethnicity and education, men with HIV were more likely to have the frailty-related phenotype for all durations of infection: for < or =4 years, the adjusted odds ratio (OR) was 3.38, with 95% confidence interval (CI), 1.25-9.11, and for 4.01-8 years and 8.01-12 years the corresponding figures were ( OR = 12.95, 95% CI, 6.60-25.40) and ( OR = 14.68, 95% CI, 7.60-28.35), respectively. The frailty-related phenotype prevalence for 55-year-old men infected with HIV for < or =4 years (3.4%; 95% CI, 1.3-8.6) was similar to that of uninfected men > or =65 years old (3.4%; 95% CI, 1.5-7.6). The authors conclude that in this cohort, HIV infection was associated with an earlier occurrence of a phenotype that resembles the phenotype of frailty in older adults without HIV infection. Studies of frailty in the setting of HIV infection may help to clarify the biological mechanism of frailty.

Editors’ note: Aging is associated with both increased risk of certain diseases and frailty involving enhanced vulnerability to stressors and impairments of immunological and inflammatory regulation. Similar mechanisms seem to be operation in HIV infection. This long-term cohort study found that the duration of HIV infection, low CD4 count, and high viral load were associated with a higher likelihood of frailty-like manifestations, suggesting that earlier treatment could potentially slow down the aging-like effects of HIV infection.