482. Frailty and Incident Hospitalization in a Cohort of HIV-Infected and Uninfected Injection Drug Users (IDUs)
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Background: Frailty, a syndrome of diminished physiologic reserve with increased stressor vulnerability, predicts hospitalization, disability and mortality in older HIV-uninfected adults.  We evaluated the effect of HIV, immune status, and viral suppression on frailty and the impact of frailty on subsequent hospitalization in an aging IDU cohort.

Methods: Frailty, defined by the presence of ≥3 of 5 standard criteria: weakness (grip strength), slowed walking speed, weight loss, low physical activity and exhaustion, was assessed biannually among a cohort of current and former injectors from 2005-2010. Correlates of frailty were assessed using repeated measures logistic regression. Cox proportional hazards models estimated risk for incident hospitalization.

Results: Of 1206 subjects at baseline, the median age was 48 years, 345 (28%) were HIV+, and frailty prevalence was 8.3% (HIV-:7.3% vs HIV+: 10.7%, p=0.05). In multivariable analysis of 3,690 person-visits, frailty was positively associated with age, female gender, socioeconomic status, depressive symptoms, and HIV. Adjusting for these factors HIV+ individuals with a CD4 <350 and detectable HIV RNA had a 1.8-fold higher likelihood of being frail compared to HIV- (OR, 1.83; 95%CI 1.29-2.61) while no increased risk was seen for those with higher CD4 counts or with HIV RNA suppression. In a separate adjusted model, absence of HAART was associated with increased frailty (OR, 1.82; 95%CI 1.28-2.59) while no difference was seen for HIV+’s on HAART compared to HIV-‘s (OR, 1.22; 95%CI 0.84-1.78). Controlling for hospitalization risk associated with sociodemographics, alcohol use, hepatitis C, and advanced HIV disease, frailty was an independent predictor of incident hospitalization  (adj HR 1.49; 95%CI 1.03-2.16), with similar risk associated with frailty among HIV+’s and HIV-‘s.

Conclusion: Our data suggest that HIV infection, particularly with inadequate virologic control, is significantly associated with frailty. Frailty assessment can inform prediction of clinical endpoints like hospitalization, notably for HIV+ patients on effective HAART. Further exploration of the underlying biological mechanisms and clinical utility of frailty may inform management of aging HIV-infected persons. 


Subject Category: H. HIV/AIDS and other retroviruses

Damani Piggott, MD, PhD1, Abimereki Muzaale, MD, MPH2, Shruti Mehta, PhD, MPH2, Todd Brown, MD, PhD2, Sean Leng, MD, PhD2 and Gregory Kirk, MD, MPH, PhD2, (1)Johns Hopkins University, Baltimore, MD, (2)Johns Hopkins University, Baltimore, MD

Disclosures:

D. Piggott, None

A. Muzaale, None

S. Mehta, None

T. Brown, None

S. Leng, None

G. Kirk, None

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