Program Schedule

1607
Veterans Aging Cohort Study (VACS) Index, Functional Status, and Other Patient Reported Outcomes in Older HIV-positive (HIV+) Adults

Session: Poster Abstract Session: HIV: Comorbidities and Coinfections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Aging HIV+ patients present challenges to overburdened health systems. To better understand this, we assessed results of comprehensive geriatric screenings in this population. We also hypothesized that age and the Veterans Aging Cohort Study (VACS) index, a validated measure of organ system dysfunction predictive of mortality, would be associated with patient-reported outcomes in older HIV+ patients

Methods: Cross-sectional survey-based study performed December 2012 – January 2014 of >50 year old HIV+ patients at two UCSF affiliated San Francisco clinics. We evaluated multiple aspects of four basic functional domains using validated measures: physical function (Activity of Daily Living/ADL, Instrumental ADL/IADL, Falls, Short Physical Performance Battery/SPPB), social support (perceived support, loneliness), mental health (depression, anxiety, post-traumatic stress/PTSD), cognitive function (Montreal Cognitive Assessment/MOCA) as well as adherence. Descriptive statistics and ANOVA analyses assessed associations between these domains with age and VACS Index scores.

Results: 359 patients were screened (median age 57; 85% males; 57% Caucasian, 30% African-American, 11% Latino; 72% >high school education). Mean CD4 count was 507 cells/mm3, 83% had undetectable viral load, and 85% were HIV-positive > 10 years. On functional screening, 26% (91) reported difficulty with ≥1 ADL, 39% (136) reported difficulty with ≥1 IADL, and 40% reported falls in the previous year. On cognitive screening, 40% had MOCA scores < 26. In addition, 58% had findings of loneliness, 60% the lowest levels of perceived social support, 55% depression, 50% anxiety, and 12% PTSD. Older age was associated with lower CD4 counts, increased difficulty with IADLs, and chair stand component of SPBB. VACS Index score was associated with IADL and medication adherence.

Conclusion: We are the first to report an association between VACS index and functional status in older HIV+ patients. Our surveys also revealed a high prevalence of functional, social and cognitive deficits in this population. More comprehensive assessment tools, incorporating the VACS index, are likely to improve predictive models and management paradigms for older HIV-infected individuals.

Malcolm John, MD, MPH1, Nancy Hessol, MSPH1, C. Bradley Hare, MD1,2, Catherine Lyons, NP, MPH1, Roland Zepf, MS, RN1, Terrence Marcotte, NP1, Amanda Hutton Parrott, DPT, MS, NP1, Robert Whirry, BA3, Cameron Foreman, BA1, Monica Gandhi, MD, MPH1 and Meredith Greene, MD1, (1)University of California San Francisco, San Francisco, CA, (2)Kaiser Permanente Medical Group San Francisco Medical Center, San Francisco, CA, (3)Robert Whirry & Associates, Los Angeles, CA

Disclosures:

M. John, None

N. Hessol, None

C. B. Hare, None

C. Lyons, None

R. Zepf, None

T. Marcotte, None

A. Hutton Parrott, None

R. Whirry, None

C. Foreman, None

M. Gandhi, None

M. Greene, None

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