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Older HIV infected adults are at risk of frailty
ResumenBackground: The percentage of HIV patients over 55 years is increasing and it presents new challenges in HIV care. It has been proposed that HIV-infection is associated with premature aging despite the administration of successful ART. It is relevant to identify older HIV patients who are at risk of unhealthy aging. In the non–HIV-infected population, frailty is a syndrome that identifies persons at risk of adverse health events, who are more vulnerable to stressors than others. Its prevalence has been little evaluated in HIV-infected patients. Objectives: to determine the prevalence of frailty in older HIV-infected adults and to describe factors related with frailty. Methods: Prospective cohort study with a three-year follow-up. This work is the phase one. Between June 2014 and June 2015, consecutive patients >55 years seen at the HIV clinics of two public university hospitals in Madrid were included in the study. Frailty was evaluated according to Fried’s criteria. We recorded sociodemographic data, comorbidities, medications, and variables related to HIV infection. We also recorded data on physical, nutritional, mental, and social status using a comprehensive geriatric assessment. Results: We evaluated 117 HIV-infected patients. Mean age was 61.3 ([CI] 55-81) years. All patients were under ART. Median current CD4+ T-cell count was 638 (144-1871) cells/µL, all but one patients were undetectable HIV RNA, and median CD4/CD8 ratio was 0.79 (0.00-3.62). The prevalence of frailty was 15.4%, and that of prefrailty 52.1%. In the univariate analysis, frailty was found to be associated with the CD4/CD8 ratio (p=0.03), an MMSE score of 19-23 (p=0.05), a GDS score <6 points (ie, depressive symptoms) (p=0.002), chronic liver disease (p=0.03), and albumin (p=0.004) The multivariate analysis revealed that only depressive symptoms increased the risk of frailty (OR [95%CI], 9.20 [2.17-39.05]), while a higher CD4/CD8 ratio was protective (OR 0.11 [0.02-0.61]). Conclusions: HIV-infected patients older than 55 years have a high prevalence of frailty. It was twice as high as that of the most representative study on frailty performed in uninfected men and women aged =65 years (7%)1, and that of the most representative Spanish frailty cohort in the general population (7.1% in community-dwelling persons aged =70 years)2. Identifying frailty older HIV patients is important to detect those with specific needs due to their vulnerabilty in order to design specific approach and interventions.
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- Póster presentado en el VIII Congreso Nacional Gesida y 10ª Reunión Docente de la Red de Investigación en Sida celebrado del 29 de noviembre al 2 de diciembre de 2016 en San Sebastián