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Frailty in HIV-Infected Adults in South Africa

Pathai, Sophia MSc, MRCOphth*,¶; Gilbert, Clare FRCOphth, MSc, MD*; Weiss, Helen A. DPhil; Cook, Colin FCOphth (SA)§,‖; Wood, Robin MMed, FCP; Bekker, Linda-Gail FCP, PhD; Lawn, Stephen D. FRCP, MD†,¶,#

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2013 - Volume 62 - Issue 1 - p 43–51
doi: 10.1097/QAI.0b013e318273b631
Clinical Science

Objectives: Some evidence suggests that HIV infection is associated with premature frailty—a syndrome typically viewed as being related to ageing. We determined the prevalence and predictors of frailty in a population of HIV-infected individuals in South Africa.

Design: Case-control study of 504 adults more than the age of 30 years, composed of 248 HIV-infected adults and 256 age- and gender-matched, frequency-matched HIV-seronegative individuals.

Methods: Frailty was defined by standardized assessment comprised of ≥3 of weight loss, low physical activity, exhaustion, weak grip strength, and slow walking time. Independent predictors of frailty were evaluated using multivariable logistic regression.

Results: The mean ages of the HIV-infected and HIV-seronegative groups were 41.1 ± 7.9 years and 42.6 ± 9.6 years, respectively. Of the HIV-infected adults, 87.1% were receiving antiretroviral treatment (median duration, 58 months), their median CD4 count was 468 cells/μL (interquartile range = 325–607 cells/μL) and 84.3% had undetectable plasma viral load. HIV-infected adults were more likely to be frail than HIV-seronegative individuals (19.4% vs. 13.3%; P = 0.07), and this association persisted after adjustment for confounding variables [adjusted OR = 2.14; 95% confidence interval (95% CI): 1.16–3.92, P = 0.01]. Among HIV-infected individuals, older age was a strong predictor of frailty, especially among women (women: OR = 2.55 per 10-year age increase; men: OR = 1.29 per 10-year age increase, P-interaction = 0.01). Lower current CD4 count (<500 cells/μL) was also independently associated with frailty (OR = 2.84; 95% CI: 1.02 –7.92, P = 0.04).

Conclusions: HIV infection is associated with premature development of frailty, especially in women. Since higher CD4 counts were associated with lower risk of frailty, earlier initiation of antiretroviral treatment may be protective.

*International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom

Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom

MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom

§Department of Ophthalmology, Faculty of Health Sciences, University of Cape Town

Groote Schuur Hospital, Cape Town, South Africa

Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

#Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.

Correspondence to: Sophia Pathai, MSc, MRCOphth, International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom (e-mail: sophia.pathai@lshtm.ac.uk).

S. Pathai was supported by the Wellcome Trust Grant #090354/Z/09/Z. R. Wood was supported by International Epidemiologic Database to Evaluate Aids (IEDEAA) 5U01AI069924-02 and Cost-Effectiveness of Preventing AIDS Complications (CEPAC) 5 R01AI058736-02. S. Lawn was supported by the Wellcome Trust Grant #088590.

The authors have no other funding or conflicts of interest to disclose.

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Received June 22, 2012

Accepted September 10, 2012

© 2013 Lippincott Williams & Wilkins, Inc.