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Association of chronic obstructive pulmonary disease with frailty measurements in HIV-infected and uninfected Veterans.

Association of chronic obstructive pulmonary disease with frailty measurements in HIV-infected and uninfected Veterans.
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Akgün KM, Tate JP, Oursler KK, Crystal S, Leaf DA, Womack JA, Brown TT, Justice AC, Crothers K,


Akgün KM, Tate JP, Oursler KK, Crystal S, Leaf DA, Womack JA, Brown TT, Justice AC, Crothers K, (click to view)

Akgün KM, Tate JP, Oursler KK, Crystal S, Leaf DA, Womack JA, Brown TT, Justice AC, Crothers K,

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AIDS (London, England) 30(14) 2185-93 doi 10.1097/QAD.0000000000001162

Abstract
OBJECTIVE
Chronic obstructive pulmonary disease (COPD) prevalence is increasing among aging HIV-infected individuals. We determined the association between COPD and self-reported measures of frailty [adapted frailty-related phenotype (aFRP)] and physical limitation, and a clinical biomarker of physiologic frailty [Veterans Aging Cohort Study (VACS) Index] in HIV-infected compared with uninfected individuals.

DESIGN
Cross-sectional study of VACS participants between 2002 and 2012.

METHODS
Prefrail/aFRP was obtained from self-reported surveys. Prefrail was defined as 1-2 domains of physical shrinking, exhaustion, slowness and low physical activity; aFRP was defined as at least 3 domains. Physical limitation scale was determined from 12 self-reported survey items assessing limitations performing physical activities. VACS index includes age and laboratory measurements. We used regression models to test for associations between COPD and outcomes in models stratified by HIV status.

RESULTS
The sample included 3538 HIV-infected and 3606 uninfected participants; 67 and 63% were black (P = 0.0003), 97 and 92% were men (P < 0.0001) and 4 and 5% had COPD (P = 0.2). In unadjusted analyses, COPD was associated with all three outcomes (P < 0.0001). In adjusted analyses, COPD was associated with increased prefrail and aFRP in HIV-infected and uninfected participants (P ≤ 0.01 for all comparisons). COPD was associated with physical limitation in both groups (P < 0.0001). There was an interaction between COPD and physical limitation by HIV status with increased physical limitation among HIV-infected participants (P = 0.04). COPD was not associated with VACS index. CONCLUSION
COPD was strongly associated with aFRP and physical limitations. COPD management may mediate frailty through functional limitations rather than physiologic biomarkers, especially in HIV-infected individuals.

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