jules levin, NATAP: more on HIV/AIDS, aging & frailty (036)


i missed a chunk from jules’ last report.



HIV-1 Infection Is Associated With an Earlier Occurrence of Frailty….in MACS

“HIV-1 Infection Is Associated With an Earlier Occurrence of a Phenotype Related to Frailty: HIV+ men in MACS 10-Times More Likely to Exhibit Frailty than HIV-negative Men”

– Frailty is a clinical syndrome associated with aging that identifies a subset … Studies offrailty in the setting of HIV infection may help to clarify …

— both HIV infection and AIDS were predictors of frailty-like manifestations, and the duration of HIV infection was associated with the likelihood of these manifestations.

— “It has been posited that HIV infection demonstrates similarities to aging and possibly to frailty (54). Specifically, HIV infection is associated with diverse impairments that resemble frailty, such as myopathy, loss of muscle mass and weight, fatigue, functional impairments, cognitive dysfunctions and motor abnormalities, as well as rheumatological disorders and neuropathies, even in the absence of identifiable opportunistic illnesses” (from Jules: senesence could be a major contributor to this)

— “The strong associations between frailty and mortality previously reported (19-24) offer the inference that the onset of frailty in the presence of these diseases may mark those individuals who are at such high risk”

– “FRP (i.e., rather than frailty)…..showed a strong association with the presence and duration of HIV infection, suggesting a basis for further work in this area. Based on these results, we are now measuring grip strength and walking speed directly in the MACS, in order to have more precise assessment of frailty in the future..”

– HIV-infected men were more likely than were uninfected men to manifest physical shrinking (odds ratio [OR] = 12.80), exhaustion (OR = 3.02), slowness (OR = 3.94), low physical activity level (OR = 3.40), and the aggregate FRP (OR = 10.97).”…..”The risk of exhibiting the FRP increased with duration of HIV infection, after adjusting for age, ethnicity, and education”…..”The estimated prevalence of the FRP for 55-year-old white non-Hispanic, college-educated men HIV-infected for ≤ 4 years was 3.4% (95% CI, 1.3-8.6), equivalent to the estimate for uninfected men of the same ethnicity and education at age 65 years or older (3.4%; 95% CI, 1.5-7.6).”…..from Jules: in table 4 below for patients without AIDS risk for frailty was 2.42 if one had HIV for <4 years but 6.25 if one had HIV for 8-12 years suggesting that frailty risk increased 3 fold after having HIV for 10 years, further suggesting the unfathomable increased risk for frailty after having HIV for 20-30 years!!!…..In figure 2a below the prevalence of frailty was 13.4% for HIV+ persons 55 years of age with HIV for 8-12 years of duration!!!! where AIDS conditions may be an issue but 5.8% where AIDS conditions may not be an issue.

Frailty Defined in Older Adults Evidence for a Phenotype
Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered …

Physical Frailty Could Predict Alzheimer’s Disease
13 (HealthDay News) — Physical frailty among the elderly may be linked to early Alzheimer’s disease, regardless of whether or not patients develop dementia …

Consequences of the Future of Aging with HIV
The MACS group has published increased risk of up to 15 times for frailty among HIV+ individuals in mACS compared to HIV-negatives. And a 55 yr old in MACS …

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