Frailty among HIV-infected persons in an urban outpatient care setting

Nur F Onen, Abayomi Agbebi, Enbal Shacham, Kate E Stamm, Alev R Onen, E Turner Overton
Journal of Infection 2009, 59 (5): 346-52

OBJECTIVES: Frailty among HIV-infected persons is increasingly recognized but data are limited. We aimed to determine frailty prevalence, predictors and clinical significance in this population.

METHODS: This was a prospective cross-sectional study of HIV-infected persons > or =18 years attending Washington University HIV Clinics between June and December 2008. Frailty was defined by > or =3 of 5 criteria: weight loss, low physical activity, exhaustion, weak grip strength and slow walking time. Independent predictors of frailty were evaluated using multivariate logistic regression analyses.

RESULTS: 445 persons were studied; mean age 41.7 years, 71% male, 63% African American with a mean 8.4 years since HIV diagnosis. 75% were on antiretroviral therapy with median CD4+437 cells/mm(3). Frailty prevalence was 9%. Independent predictors of frailty included unemployment, greater number of comorbid conditions and past opportunistic illnesses, higher depression severity score, receipt of antidepressants and lower serum albumin. Hospitalization rates were greater for frail persons with a five-fold longer duration of inpatient stay.

CONCLUSION: HIV infection was associated with a premature presentation of frailty. Frailty was associated with greater comorbidity, markers of advanced immunodeficiency and adverse socioeconomic and clinical outcomes. Further study of frailty in patients with HIV infection is warranted.

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