NATAP/Aging Wk: Low Functioning in HIV+ 52 yrs Old

[Guest guest]

Subject: NATAP/Aging Wk: Low Functioning in HIV+ 52 yrs Old

Half of HIV+ Middle-Aged Meet Social Security Disability

Threshold in Walk Test

2nd International Workshop on HIV and Aging, October 27-28, 2011, Baltimore,

land

Mark Mascolini

Seven percent of 359 middle-aged HIV-positive people tested at the University

of Colorado had poor performance on two functional status tools, and one third

to one half had only moderate function [1]. Half failed to maintain a walking

speed above 3.4 miles per hour and thus met a Social Security Administration

criterion for disability. People with low versus high functioning on the three

scoring systems had a higher risk of death according to the Veterans Aging

Cohort Study (VACS) mortality risk index.

Diverse functional status instruments have been developed to study aging, but

they have not been applied to middle-aged populations with HIV. University of

Colorado investigators compared three functional status systems with each other

and with the VACS mortality risk index in 45- to 65-year-old HIV-positive

people with one or more viral loads below 48 copies while on a stable

antiretroviral combination for more than 6 months. After reaching an

undetectable load, no one had a blip or rebound above 200 copies. The

researchers classified people as having high, moderate, or low function by Fried’s

Frailty Phenotype (FFP), the Short Physical Performance Battery (SPPB), and the

400-meter walk.

Study participants averaged 52 years in age (standard error [sE] 0.3), 85% were

men, 65% gay men, 74% Caucasian, and 18% Hispanic. CD4 counts averaged 594 (SE

16), and 95% had a viral load below 48 copies. Fewer than 1% of the study group

injected drugs or used cocaine, and only 4% downed more than 7 alcoholic drinks

a week. One third smoked and one third had quit smoking.

About 7% of study participants had low function in the FFP and SPPB systems,

and half had only moderate function by FFP or the 400-meter walk:

FFP:

Low function: 27 (7.5%)

Moderate function: 165 (46%)

High function: 167 (46.5%)

SPPB:

Low function: 26 (7%)

Moderate function: 110 (31%)

High function: 223 (62%)

400-meter walk:

Low function: 11 (3%)

Moderate function: 182 (51%)

High function: 166 (46%)

The three functional status instruments had fair agreement (61% to 64%,

weighted Kappa 0.34 to 0.41).

Across all three function systems, more reported comorbidities and medications,

diabetes, and psychiatric conditions independently predicted lower function, as

did lower self-reported activity. Variables that significantly predicted lower

function (P < 0.01) with the three

individual instruments had moderate overlap between systems, with pain the only

significant factor for all three systems:

FFP:

Pain

Falls

Neurologic disease

Psychiatric disease

SPPB:

Pain

Falls

Neurologic disease

Diabetes

Arthritis

Joint replacement

Hospitalizations

400-meter walk:

Pain

Obesity

Diabetes

Arthritis

Lung disease

The VACS mortality index, which ranges from 0 (lowest risk) to 165 (highest

risk) [2], accurately predicted 5-year all-cause mortality in this group. Median

VACS score was 18, and people with a score of 34 or higher had the highest

death risk. In all three instruments evaluated, greater impairment corresponded

with a higher VACS score. Score differences between low and high function were

8.6 for FFP (P = 0.03), 12.4 for SPPB

(P = 0.001), and 11.9 for the

400-meter walk (P = 0.08).Factors that raise the VACS score are older age, lower CD4

count, higher viral load, lower hemoglobin, higher FIB-4 fibrosis, lower

estimated glomerular filtration rate, and hepatitis C coinfection [2] (see www.vacohort.org/74621_VACS_Index_Handout_19Nov10.pdf).

The researchers cautioned that their analysis is limited by its cross-sectional

nature, by the dominance of white men in the population, and by inclusion

criteria that probably favored people more engaged in medical care.

The University of Colorado team proposed that "measurement of functional

status, identification of risk factors that may lead to functional compromise,

and interventions to reduce risks could improve successful aging and

maintenance of independence as persons with HIV age."

References

1. Erlandson KM, Allshouse AA, Jankowski C, et al. Prospective comparison of

three functional assessments with the Veteran's Aging Cohort Study index in

virologically suppressed HIV-infected adults. 2nd International Workshop on HIV

and Aging, October 27-28, 2011. Baltimore, land. Abstract O_08.

2. Justice AC, McGinnis KA, Skanderson M, et al; VACS Project Team. Towards a

combined prognostic index for survival in HIV infection: the role of 'non-HIV'

biomarkers. HIV Med. 2010;11:143-51. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077949/?tool=pubmed.