Frailty, Neurocognitive Impairment, or Both in Predicting Poor Health Outcomes Among Adults Living With Human Immunodeficiency Virus
Frailty, alone or with neurocognitive impairment, is a strong predictor of poor health outcomes within 2 years; interventions that target both frailty and neurocognitive impariments have potential to limit poor health outcomes among people aging with human immunodeficiency virus. Abstract Background...
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| Veröffentlicht in: | Clinical infectious diseases 2019-01, Vol.68 (1), p.131-138 |
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| creator | Erlandson, Kristine M Perez, Jeremiah Abdo, Mona Robertson, Kevin Ellis, Ronald J Koletar, Susan L Kalayjian, Robert Taiwo, Babafemi Palella, Frank J Tassiopoulos, Katherine |
| description | Frailty, alone or with neurocognitive impairment, is a strong predictor of poor health outcomes within 2 years; interventions that target both frailty and neurocognitive impariments have potential to limit poor health outcomes among people aging with human immunodeficiency virus.
Abstract
Background
Neurocognitive impairment (NCI) is strongly associated with frailty in people living with human immunodeficiency virus (PLWH); the overlap of frailty and NCI and the impact on health outcomes in PLWH are unknown.
Methods
PLWH in a longitudinal, observational study of aging completed entry evaluations for frailty and NCI. Outcomes of falls (recurrent) increased limitations in independent activities of daily living (IADL), or mortality were combined. Poisson regression models estimated prevalence ratios (PR) for ≥1 outcome over 2 years.
Results
Among 987 participants, the median age at entry was 51 years; 19% were female; the median CD4 count was 616 cells/µL; and HIV-1 RNA was |
| doi_str_mv | 10.1093/cid/ciy430 |
| format | Article |
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Abstract
Background
Neurocognitive impairment (NCI) is strongly associated with frailty in people living with human immunodeficiency virus (PLWH); the overlap of frailty and NCI and the impact on health outcomes in PLWH are unknown.
Methods
PLWH in a longitudinal, observational study of aging completed entry evaluations for frailty and NCI. Outcomes of falls (recurrent) increased limitations in independent activities of daily living (IADL), or mortality were combined. Poisson regression models estimated prevalence ratios (PR) for ≥1 outcome over 2 years.
Results
Among 987 participants, the median age at entry was 51 years; 19% were female; the median CD4 count was 616 cells/µL; and HIV-1 RNA was <200 copies/mL in 94%. Most (79%) participants had neither frailty nor NCI; 2% had both; 4% frailty only; and 15% NCI only. Over 2 years of observation, 100 (10%) participants experienced recurrent falls; 175 (18%) had worsening IADL limitations; 17 (2%) died; and 254 (26%) experienced ≥1 poor health outcome. In adjusted models, frailty with NCI was associated with more than double the risk of a poor health outcome (PR 2.65; 95% CI 1.98, 3.54); a significant association was also seen with frailty alone (PR 2.26; 95%CI 1.71, 2.99) and NCI alone (PR 1.73; 95% CI 1.36, 2.20).
Conclusions
The presence of frailty with NCI was associated with a greater risk of falls, disability, or death in PLWH than NCI alone. Interventions that target prevention or reversal of both frailty and NCI (such as increased physical activity) may significantly limit poor health outcomes among PLWH.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciy430</identifier><identifier>PMID: 29788039</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adult ; and Commentaries ; Clinical Decision Rules ; Cognitive Dysfunction - complications ; Cognitive Dysfunction - diagnosis ; Cognitive Dysfunction - pathology ; Frailty - complications ; Frailty - diagnosis ; Frailty - pathology ; HIV Infections - complications ; HIV Infections - diagnosis ; HIV Infections - pathology ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Prognosis</subject><ispartof>Clinical infectious diseases, 2019-01, Vol.68 (1), p.131-138</ispartof><rights>The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-a74e339b55548ac9dc2e5d724da9807662056010cf7f4cde0e00d083276018173</citedby><cites>FETCH-LOGICAL-c408t-a74e339b55548ac9dc2e5d724da9807662056010cf7f4cde0e00d083276018173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29788039$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Erlandson, Kristine M</creatorcontrib><creatorcontrib>Perez, Jeremiah</creatorcontrib><creatorcontrib>Abdo, Mona</creatorcontrib><creatorcontrib>Robertson, Kevin</creatorcontrib><creatorcontrib>Ellis, Ronald J</creatorcontrib><creatorcontrib>Koletar, Susan L</creatorcontrib><creatorcontrib>Kalayjian, Robert</creatorcontrib><creatorcontrib>Taiwo, Babafemi</creatorcontrib><creatorcontrib>Palella, Frank J</creatorcontrib><creatorcontrib>Tassiopoulos, Katherine</creatorcontrib><title>Frailty, Neurocognitive Impairment, or Both in Predicting Poor Health Outcomes Among Adults Living With Human Immunodeficiency Virus</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Frailty, alone or with neurocognitive impairment, is a strong predictor of poor health outcomes within 2 years; interventions that target both frailty and neurocognitive impariments have potential to limit poor health outcomes among people aging with human immunodeficiency virus.
Abstract
Background
Neurocognitive impairment (NCI) is strongly associated with frailty in people living with human immunodeficiency virus (PLWH); the overlap of frailty and NCI and the impact on health outcomes in PLWH are unknown.
Methods
PLWH in a longitudinal, observational study of aging completed entry evaluations for frailty and NCI. Outcomes of falls (recurrent) increased limitations in independent activities of daily living (IADL), or mortality were combined. Poisson regression models estimated prevalence ratios (PR) for ≥1 outcome over 2 years.
Results
Among 987 participants, the median age at entry was 51 years; 19% were female; the median CD4 count was 616 cells/µL; and HIV-1 RNA was <200 copies/mL in 94%. Most (79%) participants had neither frailty nor NCI; 2% had both; 4% frailty only; and 15% NCI only. Over 2 years of observation, 100 (10%) participants experienced recurrent falls; 175 (18%) had worsening IADL limitations; 17 (2%) died; and 254 (26%) experienced ≥1 poor health outcome. In adjusted models, frailty with NCI was associated with more than double the risk of a poor health outcome (PR 2.65; 95% CI 1.98, 3.54); a significant association was also seen with frailty alone (PR 2.26; 95%CI 1.71, 2.99) and NCI alone (PR 1.73; 95% CI 1.36, 2.20).
Conclusions
The presence of frailty with NCI was associated with a greater risk of falls, disability, or death in PLWH than NCI alone. Interventions that target prevention or reversal of both frailty and NCI (such as increased physical activity) may significantly limit poor health outcomes among PLWH.</description><subject>Adult</subject><subject>and Commentaries</subject><subject>Clinical Decision Rules</subject><subject>Cognitive Dysfunction - complications</subject><subject>Cognitive Dysfunction - diagnosis</subject><subject>Cognitive Dysfunction - pathology</subject><subject>Frailty - complications</subject><subject>Frailty - diagnosis</subject><subject>Frailty - pathology</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - diagnosis</subject><subject>HIV Infections - pathology</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prognosis</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUuLFDEUhYMozkM3_gDJRhCZ0ptKpSq1EdrBsQcaZxY-liGTpHoilaQnj4bezw83TY-DblyEG-75OPdeDkKvCLwnMNIPyur6dh2FJ-iYMDo0PRvJ0_oHxpuOU36ETlL6BUAIB_YcHbXjwDnQ8RjdX0Rp57w7w19NiUGFtbfZbg2-dBtpozM-n-EQ8aeQb7H1-DoabVW2fo2vQ-0vjZyrclWyCs4kvHChSgtd5pzwym734E9biWVx0ldXV3zQZrLKGq92-IeNJb1AzyY5J_PyoZ6i7xefv50vm9XVl8vzxapRHfDcyKEzlI43jLGOSzVq1Rqmh7bTcuQw9H0LrAcCahqmTmkDBkADp-1Qu5wM9BR9PPhuyo0zWtXjopzFJlon404EacW_ire3Yh22om9HCtBWg7cPBjHcFZOycDYpM8_Sm1CSaKGjhNOe7We9O6AqhpSimR7HEBD72ESNTRxiq_Drvxd7RP_kVIE3ByCUzf-MfgO6CqLL</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Erlandson, Kristine M</creator><creator>Perez, Jeremiah</creator><creator>Abdo, Mona</creator><creator>Robertson, Kevin</creator><creator>Ellis, Ronald J</creator><creator>Koletar, Susan L</creator><creator>Kalayjian, Robert</creator><creator>Taiwo, Babafemi</creator><creator>Palella, Frank J</creator><creator>Tassiopoulos, Katherine</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190101</creationdate><title>Frailty, Neurocognitive Impairment, or Both in Predicting Poor Health Outcomes Among Adults Living With Human Immunodeficiency Virus</title><author>Erlandson, Kristine M ; Perez, Jeremiah ; Abdo, Mona ; Robertson, Kevin ; Ellis, Ronald J ; Koletar, Susan L ; Kalayjian, Robert ; Taiwo, Babafemi ; Palella, Frank J ; Tassiopoulos, Katherine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-a74e339b55548ac9dc2e5d724da9807662056010cf7f4cde0e00d083276018173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>and Commentaries</topic><topic>Clinical Decision Rules</topic><topic>Cognitive Dysfunction - complications</topic><topic>Cognitive Dysfunction - diagnosis</topic><topic>Cognitive Dysfunction - pathology</topic><topic>Frailty - complications</topic><topic>Frailty - diagnosis</topic><topic>Frailty - pathology</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - diagnosis</topic><topic>HIV Infections - pathology</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prognosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Erlandson, Kristine M</creatorcontrib><creatorcontrib>Perez, Jeremiah</creatorcontrib><creatorcontrib>Abdo, Mona</creatorcontrib><creatorcontrib>Robertson, Kevin</creatorcontrib><creatorcontrib>Ellis, Ronald J</creatorcontrib><creatorcontrib>Koletar, Susan L</creatorcontrib><creatorcontrib>Kalayjian, Robert</creatorcontrib><creatorcontrib>Taiwo, Babafemi</creatorcontrib><creatorcontrib>Palella, Frank J</creatorcontrib><creatorcontrib>Tassiopoulos, Katherine</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Erlandson, Kristine M</au><au>Perez, Jeremiah</au><au>Abdo, Mona</au><au>Robertson, Kevin</au><au>Ellis, Ronald J</au><au>Koletar, Susan L</au><au>Kalayjian, Robert</au><au>Taiwo, Babafemi</au><au>Palella, Frank J</au><au>Tassiopoulos, Katherine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Frailty, Neurocognitive Impairment, or Both in Predicting Poor Health Outcomes Among Adults Living With Human Immunodeficiency Virus</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>68</volume><issue>1</issue><spage>131</spage><epage>138</epage><pages>131-138</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Frailty, alone or with neurocognitive impairment, is a strong predictor of poor health outcomes within 2 years; interventions that target both frailty and neurocognitive impariments have potential to limit poor health outcomes among people aging with human immunodeficiency virus.
Abstract
Background
Neurocognitive impairment (NCI) is strongly associated with frailty in people living with human immunodeficiency virus (PLWH); the overlap of frailty and NCI and the impact on health outcomes in PLWH are unknown.
Methods
PLWH in a longitudinal, observational study of aging completed entry evaluations for frailty and NCI. Outcomes of falls (recurrent) increased limitations in independent activities of daily living (IADL), or mortality were combined. Poisson regression models estimated prevalence ratios (PR) for ≥1 outcome over 2 years.
Results
Among 987 participants, the median age at entry was 51 years; 19% were female; the median CD4 count was 616 cells/µL; and HIV-1 RNA was <200 copies/mL in 94%. Most (79%) participants had neither frailty nor NCI; 2% had both; 4% frailty only; and 15% NCI only. Over 2 years of observation, 100 (10%) participants experienced recurrent falls; 175 (18%) had worsening IADL limitations; 17 (2%) died; and 254 (26%) experienced ≥1 poor health outcome. In adjusted models, frailty with NCI was associated with more than double the risk of a poor health outcome (PR 2.65; 95% CI 1.98, 3.54); a significant association was also seen with frailty alone (PR 2.26; 95%CI 1.71, 2.99) and NCI alone (PR 1.73; 95% CI 1.36, 2.20).
Conclusions
The presence of frailty with NCI was associated with a greater risk of falls, disability, or death in PLWH than NCI alone. Interventions that target prevention or reversal of both frailty and NCI (such as increased physical activity) may significantly limit poor health outcomes among PLWH.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>29788039</pmid><doi>10.1093/cid/ciy430</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical infectious diseases, 2019-01, Vol.68 (1), p.131-138 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult and Commentaries Clinical Decision Rules Cognitive Dysfunction - complications Cognitive Dysfunction - diagnosis Cognitive Dysfunction - pathology Frailty - complications Frailty - diagnosis Frailty - pathology HIV Infections - complications HIV Infections - diagnosis HIV Infections - pathology Humans Longitudinal Studies Male Middle Aged Prognosis |
| title | Frailty, Neurocognitive Impairment, or Both in Predicting Poor Health Outcomes Among Adults Living With Human Immunodeficiency Virus |
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