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Predictors of transitions in frailty severity and mortality among people aging with HIV.

Predictors of transitions in frailty severity and mortality among people aging with HIV.
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Brothers TD, Kirkland S, Theou O, Zona S, Malagoli A, Wallace LMK, Stentarelli C, Mussini C, Falutz J, Guaraldi G, Rockwood K,


Brothers TD, Kirkland S, Theou O, Zona S, Malagoli A, Wallace LMK, Stentarelli C, Mussini C, Falutz J, Guaraldi G, Rockwood K, (click to view)

Brothers TD, Kirkland S, Theou O, Zona S, Malagoli A, Wallace LMK, Stentarelli C, Mussini C, Falutz J, Guaraldi G, Rockwood K,

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PloS one 2017 10 0512(10) e0185352 doi 10.1371/journal.pone.0185352

Abstract
BACKGROUND
People aging with HIV show variable health trajectories. Our objective was to identify longitudinal predictors of frailty severity and mortality among a group aging with HIV.

METHODS
Exploratory analyses employing a multistate transition model, with data from the prospective Modena HIV Metabolic Clinic Cohort Study, based in Northern Italy, begun in 2004. Participants were followed over four years from their first available visit. We included all 963 participants (mean age 46.8±7.1; 29% female; 89% undetectable HIV viral load; median current CD4 count 549, IQR 405-720; nadir CD4 count 180, 81-280) with four-year data. Frailty was quantified using a 31-item frailty index. Outcomes were frailty index score or mortality at four-year follow-up. Candidate predictor variables were baseline frailty index score, demographic (age, sex), HIV-disease related (undetectable HIV viral load, current CD4+ T-cell count, nadir CD4 count, duration of HIV infection, and duration of antiretroviral therapy [ARV] exposure), and behavioral factors (smoking, injection drug use (IDU), and hepatitis C virus co-infection).

RESULTS
Four-year mortality was 3.0% (n = 29). In multivariable analyses, independent predictors of frailty index at follow-up were baseline frailty index (RR 1.06, 95% CI 1.05-1.07), female sex (RR 0.93, 95% CI 0.87-0.98), nadir CD4 cell count (RR 0.96, 95% CI 0.93-0.99), duration of HIV infection (RR 1.06, 95% CI 1.01-1.12), duration of ARV exposure (RR 1.08, 95% CI 1.02-1.14), and smoking pack-years (1.03, 1.01-1.05). Independent predictors of mortality were baseline frailty index (OR 1.19, 1.02-1.38), current CD4 count (0.34, 0.20-0.60), and IDU (2.89, 1.30-6.42).

CONCLUSIONS
Demographic, HIV-disease related, and social and behavioral factors appear to confer risk for changes in frailty severity and mortality among people aging with HIV.

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