Association of Age and Comorbidity with Physical Function in HIV-Infected and Uninfected Patients: Results from the Veterans Aging Cohort Study

Departement of Medicine, University of Maryland School of Medicine, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland 21201-1524, USA.
AIDS patient care and STDs (Impact Factor: 3.5). 01/2011; 25(1):13-20. DOI: 10.1089/apc.2010.0242
Source: PubMed


HIV clinical care now involves prevention and treatment of age-associated comorbidity. Although physical function is an established correlate to comorbidity in older adults without HIV infection, its role in aging of HIV-infected adults is not well understood. To investigate this question we conducted cross-sectional analyses including linear regression models of physical function in 3227 HIV-infected and 3240 uninfected patients enrolled 2002-2006 in the Veterans Aging Cohort Study-8-site (VACS-8). Baseline self-reported physical function correlated with the Short Form-12 physical subscale (ρ = 0.74, p < 0.001), and predicted survival. Across the age groups decline in physical function per year was greater in HIV-infected patients (β(coef) -0.25, p < 0.001) compared to uninfected patients (β(coef) -0.08, p = 0.03). This difference, although statistically significant (p < 0.01), was small. Function in the average 50-year old HIV-infected subject was equivalent to the average 51.5-year-old uninfected subject. History of cardiovascular disease was a significant predictor of poor function, but the effect was similar across groups. Chronic pulmonary disease had a differential effect on function by HIV status (Δβ(coef) -3.5, p = 0.03). A 50-year-old HIV-infected subject with chronic pulmonary disease had the equivalent level of function as a 68.1-year-old uninfected subject with chronic pulmonary disease. We conclude that age-associated comorbidity affects physical function in HIV-infected patients, and may modify the effect of aging. Longitudinal research with markers of disease severity is needed to investigate loss of physical function with aging, and to develop age-specific HIV care guidelines.

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Available from: Kris Ann Oursler, Aug 03, 2015
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    • "Previous studies comparing the prevalence of comorbidities between HIV-infected and HIV-uninfected individuals showed discrepant results, however. The prospective cross-sectional study by Onen et al showed that HIV-infected patients in the US had a higher prevalence of hypertension and hypertriglyceridemia than HIV-uninfected individuals [18], while the VACS study by Oursler et al showed that HIV-uninfected individuals in the US had a higher prevalence of hypertension and diabetes mellitus than HIV-infected patients [12]. "
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    ABSTRACT: Background With the widespread use of combination antiretroviral therapy (cART), life expectancy of HIV-infected patients has significantly prolonged. An increasing number of HIV-infected patients are aging and concurrent use of medications are not uncommon for management of metabolic complications and cardiovascular diseases related to aging and prolonged exposure to cART. Methods We reviewed medical records of all HIV-infected patients aged 40 years or older who had been followed at a university hospital for HIV care in Taiwan between January and December 2013. A standardized case record form was used to collect information on demographics and clinical characteristics, comorbidity, cART, and concurrent medications. Results During the study period, 610 patients aged 40 to 49 years (mean, 44.1) and 310 aged 50 years or older (mean, 58.8) sought HIV care at this hospital. Compared with patients aged 40 to 49 years, those aged 50 years or older were significantly more likely to be female (15.9% vs 3.8%); to have received cART (97.7% vs 94.8%) and a lower plasma HIV RNA load (1.6 vs 1.7 log10 copies/ml); and to have diabetes mellitus (18.4% vs 4.6%), hypertension (31.0% vs 10.8%), hyperlipidemia (29.4% vs 11.6%), coronary artery disease (6.8% vs 0.5%), and an estimated glomerular filtration rate <60 ml/min/1.73 m2 (11.5% vs 2.7%); and were significantly less likely to have syphilis. Other than HIV infection, patients aged 50 years or older were more likely to have been receiving two or more concurrent medications than those aged 40 to 49 years (22.9% vs 6.4%). Conclusions Our findings show a significant proportion of the HIV-infected patients aged 50 years or older have multiple comorbidities that may increase the risk for cardiovascular and renal complications. Issues of poly-pharmacy among the HIV-infected patients who are aging should be addressed to ensure adherence and minimize drug-drug interactions.
    PLoS ONE 08/2014; 9(8):e104945. DOI:10.1371/journal.pone.0104945 · 3.23 Impact Factor
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    AIDS patient care and STDs 09/2011; 25(9):539-45. DOI:10.1089/apc.2011.0026 · 3.50 Impact Factor
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    Clinical Infectious Diseases 12/2011; 53(12):1256-64. DOI:10.1093/cid/cir673 · 8.89 Impact Factor
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