Baseline Neurocognitive Impairment (NCI) Is Associated With Incident Frailty but Baseline Frailty Does Not Predict Incident NCI in Older Persons With Human Immunodeficiency Virus (HIV)

Mary Clare Masters; Jeremiah Perez; Kunling Wu; Ronald J Ellis; Karl Goodkin; Susan L Koletar; Adriana Andrade; Jingyan Yang; Todd T Brown; Frank J Palella; Ned Sacktor; Katherine Tassiopoulos; Kristine M Erlandson

doi:10.1093/cid/ciab122

Baseline Neurocognitive Impairment (NCI) Is Associated With Incident Frailty but Baseline Frailty Does Not Predict Incident NCI in Older Persons With Human Immunodeficiency Virus (HIV)

Clin Infect Dis. 2021 Aug 16;73(4):680-688. doi: 10.1093/cid/ciab122.

Authors

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
² Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
³ University of California, San Diego, San Diego, California, USA.
⁴ University of Nebraska Medical Center, Omaha, Omaha, Nebraska, USA.
⁵ The Ohio State University, Columbus, Ohio, USA.
⁶ DHHS/NIH/NIAID/DAIDS, Rockville, Maryland, USA.
⁷ Columbia University, New York, New York, USA.
⁸ Johns Hopkins University, Baltimore, Maryland, USA.
⁹ University of Colorado- Anschutz Medical Campus, Aurora, Colorado, USA.

Abstract

Background: Neurocognitive impairment (NCI) and frailty are more prevalent among persons with human immunodeficiency virus (HIV, PWH) compared to those without HIV. Frailty and NCI often overlap with one another. Whether frailty precedes declines in neurocognitive function among PWH or vice versa has not been well established.

Methods: AIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH. Participants undergo annual assessments for NCI and frailty. ACTG A5322 participants who developed NCI as indexed by tests of impaired executive functioning and processing speed during the first 3 years were compared to persons who maintained normal cognitive function; those who demonstrated resolution of NCI were compared to those who had persistent NCI. Participants were similarly compared by frailty trajectory. We fit multinomial logistic regression models to assess associations between baseline covariates (including NCI) and frailty, and associations between baseline covariates (including frailty) and NCI.

Results: In total, 929 participants were included with a median age of 51 years (interquartile range [IQR] 46-56). At study entry, 16% had NCI, and 6% were frail. Over 3 years, 6% of participants developed NCI; 5% developed frailty. NCI was associated with development of frailty (odds ratio [OR] = 2.06; 95% confidence interval [CI] = .94, 4.48; P = .07). Further adjustment for confounding strengthened this association (OR = 2.79; 95% CI = 1.21, 6.43; P = .02). Baseline frailty however was not associated with NCI development.

Conclusions: NCI was associated with increased risk of frailty, but frailty was not associated with development of NCI. These findings suggest that the presence of NCI in PWH should prompt monitoring for the development of frailty and interventions to prevent frailty in this population.

Keywords: HIV; aging; frailty; neurocognitive impairment.

Publication types

Observational Study
Research Support, N.I.H., Extramural

MeSH terms

Aged
Aged, 80 and over
Cohort Studies
Frailty* / epidemiology
HIV
HIV Infections* / complications
Humans
Middle Aged
Odds Ratio

Abstract

Publication types

MeSH terms

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