Physical Function Impairment and Frailty in Middle-Aged People Living With Human Immunodeficiency Virus in the REPRIEVE Trial Ancillary Study PREPARE

The Journal of Infectious Diseases, July 2020

As the lifespan of people living with HIV increases, so too do the number of people aging with HIV (nearly half of people living with HIV in the United States are now at least 50 years old). Compared to people without HIV, physical function impairment and frailty are more common and occur at an earlier age in people living with HIV; both have been associated with increased risk of falls, hospitalizations, and death. This paper describes physical function impairment and frailty in middle-aged people living with HIV on stable ART when they enrolled in A5361S (PREPARE), a substudy of REPRIEVE.

A5361S evaluated 266 people living with HIV in the United States, nearly all in their 40s or 50s (81% male, 47% White, 45% Black, 18% Latinx). Many had high body mass index (BMI) and levels of physical activity were low. The investigators found that while overt frailty was uncommon (6%), physical function impairments and pre-frailty were present in nearly half of participants. Physical function impairments appeared mostly in power (the ability to rise from a chair) or strength (grip), important manifestations of skeletal muscle function.

These findings suggest that the time it takes you to stand up from a chair may be a useful screening tool in this relatively young population to detect subtle changes in physical function earlier in age. Additionally, greater BMI, physical inactivity, smoking, and hypertension were associated with physical function impairments. These are important modifiable factors to help target interventions to potentially delay or reduce physical function impairments. The team is continuing to assess physical function yearly to understand any effects of statins over time.

Bottom line: In this relatively younger population with HIV, changes in healthy physical function appeared earlier. Need to learn more about why this happens and the best ways to combat it.

Umbleja, T., Brown, T. T., Overton, E. T., Ribaudo, H. J., Schrack, J. A., Fitch, K. V., Douglas, P. S., Grinspoon, S. K., Henn, S., Arduino, R. C., Rodriguez, B., Benson, C. A., & Erlandson, K. M. (2020). Physical Function Impairment and Frailty in Middle-Aged People Living With Human Immunodeficiency Virus in the REPRIEVE Trial Ancillary Study PREPAREThe Journal of infectious diseases222(Suppl 1), S52–S62. https://doi.org/10.1093/infdis/jiaa249