Functional Impairment, Disability, and Frailty in Adults Aging with HIV-Infection
- 665 Downloads
The integration of antiretroviral therapy (i.e., ART) into HIV care has dramatically extended the life expectancy of those living with HIV. However, in comparison to similar HIV-uninfected populations, HIV-infected persons experience an excess of morbidity and mortality with an early onset of aging complications including neurocognitive decline, osteoporosis, impaired physical function, frailty, and falls. Recent consensus guidelines encourage clinicians and researchers to consider functional impairment of HIV-infected adults as a measure to understand the impact of aging across a range of abilities. Despite the importance of assessing function in persons aging with HIV infection, a lack of consistent terminology and standardization of assessment tools has limited the application of functional assessments in clinical or research settings. Herein, we distinguish between different approaches used to assess function, describe what is known about function in the aging HIV population, and consider directions for future research.
KeywordsHIV Frailty Physical function Functional impairment Functional limitation Quality of life Disability Aging
This work was supported by the National Institutes of Health [R03AG040594-01] and the Hartford Foundation Center of Excellence in Geriatric Medicine. Contents are the authors’ sole responsibility and do not necessarily represent official NIH views.
Compliance with Ethics Guidelines
Conflict of Interest
Jennifer A. Schrack and Catherine M. Jankowski declare that they have no conflict of interest.
Kristine M. Erlandson reports grants from Hartford Foundation, grants from NIH, during the conduct of the study.
Todd T. Brown reports personal fees from Merck, personal fees from ViiV Healthcare, personal fees from Abbvie, personal fees from EMD-Serono, personal fees from Gilead, outside the submitted work.
Thomas B. Campbell reports grants from US NIH, during the conduct of the study; personal fees from Gilead Sciences, outside the submitted work; has served as a consultant to Merck, ViiV Healthcare, Abbvie, EMD-Serono, and Gilead.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.••Summary report from the Human Immunodeficiency Virus and Aging Consensus Project: treatment strategies for clinicians managing older individuals with the human immunodeficiency virus. J Am Geriatr Soc 2012,60:974-979. This is a nice summary of the key points from the HIV and Aging Consensus Project document and highlights issues in clinical care and research priorities. Google Scholar
- 4.Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 2008,372:293-299.Google Scholar
- 16.Terzian AS, Holman S, Nathwani N, Robison E, Weber K, Young M, et al. Factors associated with preclinical disability and frailty among HIV-infected and HIV-uninfected women in the era of cART. J Womens Health. 2009;18:1965–74.Google Scholar
- 18.Holroyd-Leduc JM, Reddy M. Evidence-based geriatric medicine : a practical clinical guide. Chichester: Blackwell Pub; 2012.Google Scholar
- 21.••High KP, Brennan-Ing M, Clifford DB, Cohen MH, Currier J, Deeks SG, et al. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group. J Acquir Immunodef Syndr. 2012;60 Suppl 1:S1–18. A high yield summary of priority areas in HIV and Aging as identified by leaders and funding agencies.Google Scholar
- 27.Kelley AS, Ettner SL, Morrison RS, Du Q, Sarkisian CA. Disability and Decline in Physical Function Associated with Hospital Use at End of Life. J Gen Intern Med 2012Google Scholar
- 37.In: The Future of Disability in America. Edited by Field MJ, Jette AM. Washington (DC); 2007.Google Scholar
- 40.Patrick DL, Erickson P. Health status and health policy : quality of life in health care evaluation and resource allocation. New York: Oxford University Press; 1993.Google Scholar
- 46.Longenberger A, Lim JY, Brown TT, Abraham A, Palella FJ, Effros RB, et al. Low physical function as a risk factor for incident diabetes mellitus and insulin resistance. Futur Virol. 2011;6:439–49.Google Scholar
- 73.Avila-Funes JA, Amieva H. Frailty: an overused term among the elderly… even in gastroenterology. J Clin Gastroenterol 2009,43:199; author reply 199.Google Scholar
- 74.Margolick JB, Chopra RK. Relationship between the immune system and frailty: pathogenesis of immune deficiency in HIV infection and aging. Aging (Milano). 1992;4:255–7.Google Scholar
- 75.•Althoff KN, Jacobson LP, Cranston RD, Detels R, Phair JP, Li X, et al. Age, Comorbidities, and AIDS Predict a Frailty Phenotype in Men Who Have Sex With Men. J Gerontol A Biol Sci Med Sci. 2013. doi: 10.1093/gerona/glt148. Using the frailty-related phenotype in the MACS Cohort, these authors provide the first data on the stability of the frail state among HIV-infected men and clinical risk factors associated with transition in or out of the frail state. PubMedGoogle Scholar
- 76.•Piggott DA, Muzaale AD, Mehta SH, Brown TT, Patel KV, Leng SX, et al. Frailty, HIV infection, and mortality in an aging cohort of injection drug users. PLoS One. 2013;8:e54910. This study in a nicely matched cohort of HIV-infected and HIV-uninfected intravenous drug users demonstrates the synergistic effect of both frailty and HIV in predicting mortality. PubMedCentralPubMedGoogle Scholar
- 77.Onen NF, Patel P, Baker J, Conley L, Brooks JT, Bush T, et al. Frailty and pre-frailty in a contemporary cohort of HIV-infected adults. The Journal of Frailty & Aging 2013Google Scholar
- 78.Rees HC, Ianas V, McCracken P, Smith S, Georgescu A, Zangeneh T, et al. Measuring frailty in HIV-infected individuals. Identification of frail patients is the first step to amelioration and reversal of frailty. J Vis Exp 2013.Google Scholar
- 92.Campo M, Oursler KK, Huang L, Goetz MB, Rimland D, Hoo GS, et al. Association of Chronic Cough and Pulmonary Function With 6-Minute Walk Test Performance in HIV Infection. JAIDS J Acquir Immune Defic Syndr. 2014;65:557–63.Google Scholar
- 93.Grinspoon S, Corcoran C, Rosenthal D, Stanley T, Parlman K, Costello M, et al. Quantitative assessment of cross-sectional muscle area, functional status, and muscle strength in men with the acquired immunodeficiency syndrome wasting syndrome. J Clin Endocrinol Metab. 1999;84:201–6.PubMedGoogle Scholar
- 96.Robertson K, Jiang H, Kumwenda J, Supparatpinyo K, Evans S, Campbell TB, et al. Improved neuropsychological and neurological functioning across three antiretroviral regimens in diverse resource-limited settings: AIDS Clinical Trials Group study a5199, the International Neurological Study. Clin Infect Dis. 2012;55:868–76.PubMedCentralPubMedGoogle Scholar
- 99.Souza PM, Jacob-Filho W, Santarem JM, Zomignan AA, Burattini MN. Effect of progressive resistance exercise on strength evolution of elderly patients living with HIV compared to healthy controls. Clinics (Sao Paulo). 2011;66:261–6.Google Scholar
- 101.Baranoski AS, Harris A, Michaels D, Miciek R, Storer T, Sebastiani P, et al. Relationship Between Poor Physical Function, Inflammatory Markers, and Comorbidities in HIV-Infected Women on Antiretroviral Therapy. J Womens Health (Larchmt). 2014;23:69–76.Google Scholar
- 102.•Richert L, Brault M, Mercie P, Dauchy FA, Bruyand M, Greib C, et al. Decline in locomotor functions over time in HIV-infected patients. AIDS. 2014. doi: 10.1097/QAD.0000000000000246. Although the follow-up time was short, this study provides some of the first rates of change in several measures of objective physical function, essential data needed to power future interventional studies to prevent physical function decline. Google Scholar