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Current HIV Research

Editor-in-Chief

ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

Research Article

Frailty among HIV-1 Infected Adults under Antiretroviral Therapy in Indonesia

Author(s): Wulunggono Wulunggono, Evy Yunihastuti*, Hamzah Shatri, Edy Rizal Wahyudi and Youdiil Ophinni

Volume 17, Issue 3, 2019

Page: [204 - 213] Pages: 10

DOI: 10.2174/1570162X17666190828143947

open access plus

Abstract

Background: Increasing age of HIV-1 infected population brought about the risk of frailty as comorbidity, whose prevalence is higher in low and middle-income countries (LMICs). Indonesia as an LMIC also bears a major burden of HIV-1 epidemic with a similarly aging population, but the prevalence of frailty and its predictors are unknown.

Objectives: To identify the prevalence of frailty and analyze its associated factors, among HIV-1 infected adults under antiretroviral therapy in Indonesia.

Methods: A cross-sectional study was conducted among HIV-infected individuals with inclusion criteria of age ≥30 years old and underwent ART for at least 6 months. The main assessment was done using Fried’s frailty phenotype score, which categorizes subjects into non-frail, pre-frail, or frail. Factors associated with frailty were characterized and multiple logistic regression analysis was performed.

Results: A total of 164 subjects were recruited; male subjects were 118 (72%), the median age was 40.5 years old, and the median CD4 nadir was 53 cells/μl. Frailty was identified among 90 (54.9%) subjects with 84 (51.2%) identified as pre-frail and 6 (3.7%) as frail, with dominant frailty phenotype was weakness in grip strength. The multivariate model showed that depression was the only factor significantly correlated with pre-frailty and frailty (OR 2.14; 95% CI 1.04-4.43, p=0.036).

Conclusion: Frailty is a common occurrence among HIV-infected patients under ART, with depression as an independent predictive factor.

Keywords: HIV-1, AIDS, frailty, antiretroviral therapy, depression, LMIC.

Graphical Abstract

[1]
Autenrieth CS, Beck EJ, Stelzle D, Mallouris C, Mahy M, Ghys P. Global and regional trends of people living with HIV aged 50 and over: Estimates and projections for 2000-2020. PLoS One 2018; 13(11)e0207005
[http://dx.doi.org/10.1371/journal.pone.0207005] [PMID: 30496302]
[2]
Smit M, Brinkman K, Geerlings S, et al. ATHENA observational cohort. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis 2015; 15(7): 810-8.
[http://dx.doi.org/10.1016/S1473-3099(15)00056-0] [PMID: 26070969]
[3]
Nakagawa F, Lodwick RK, Smith CJ, et al. Projected life expectancy of people with HIV according to timing of diagnosis. AIDS 2012; 26(3): 335-43.
[http://dx.doi.org/10.1097/QAD.0b013e32834dcec9] [PMID: 22089374]
[4]
Nakagawa F, May M, Phillips A. Life expectancy living with HIV: recent estimates and future implications. Curr Opin Infect Dis 2013; 26(1): 17-25.
[http://dx.doi.org/10.1097/QCO.0b013e32835ba6b1] [PMID: 23221765]
[5]
UNAIDS. Global HIV/AIDS statistics: 2018 fact sheet [Internet]. 2018..Available from:. http://www.unaids.org/En/Resources/Fact-Sheet
[6]
Saag MS, Benson CA, Gandhi RT, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 recommendations of the international antiviral society-USA panel. JAMA 2018; 320(4): 379-96.
[http://dx.doi.org/10.1001/jama.2018.8431] [PMID: 30043070]
[7]
Justice AC. HIV and aging: Time for a new paradigm. Curr HIV/AIDS Rep 2010; 7(2): 69-76.
[http://dx.doi.org/10.1007/s11904-010-0041-9] [PMID: 20425560]
[8]
Justice A, Falutz J. Aging and HIV: An evolving understanding. Curr Opin HIV AIDS 2014; 9(4): 291-3.
[http://dx.doi.org/10.1097/COH.0000000000000081] [PMID: 24871091]
[9]
Deeks SG. HIV infection, inflammation, immunosenescence, and aging. Annu Rev Med 2011; 62(1): 141-55.
[http://dx.doi.org/10.1146/annurev-med-042909-093756] [PMID: 21090961]
[10]
Hasse B, Ledergerber B, Furrer H, et al. Swiss HIV Cohort Study. Morbidity and aging in HIV-infected persons: The Swiss HIV cohort study. Clin Infect Dis 2011; 53(11): 1130-9.
[http://dx.doi.org/10.1093/cid/cir626] [PMID: 21998280]
[11]
Cardoso SW, Torres TS, Santini-Oliveira M, Marins LMS, Veloso VG, Grinsztejn B. Aging with HIV: A practical review. Braz J Infect Dis 2013; 17(4): 464-79.
[http://dx.doi.org/10.1016/j.bjid.2012.11.007] [PMID: 23711587]
[12]
Wing EJ. HIV and aging. Int J Infect Dis 2016; 53: 61-8.
[http://dx.doi.org/10.1016/j.ijid.2016.10.004] [PMID: 27756678]
[13]
Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: A call to action. J Am Med Dir Assoc 2013; 14(6): 392-7.
[http://dx.doi.org/10.1016/j.jamda.2013.03.022] [PMID: 23764209]
[14]
Chen X, Mao G, Leng SX. Frailty syndrome: An overview. Clin Interv Aging 2014; 9: 433-41.
[PMID: 24672230]
[15]
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol ser A Biol Sci Med Sci 2001; 56(3): M146-56.
[http://dx.doi.org/10.1093/gerona/56.3.m146] [PMID: 11253156]
[16]
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013; 381(9868): 752-62.
[http://dx.doi.org/10.1016/S0140-6736(12)62167-9] [PMID: 23395245]
[17]
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. Journals Gerontol Ser A Biol Sci. Med Sci 2004; 59(3): M255-63.
[18]
Op het Veld LPM, van Rossum E, Kempen GIJM, de Vet HCW, Hajema K, Beurskens AJHM. Fried phenotype of frailty: Cross-sectional comparison of three frailty stages on various health domains. BMC Geriatr 2015; 15(1): 77.
[http://dx.doi.org/10.1186/s12877-015-0078-0] [PMID: 26155837]
[19]
Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med 2011; 27(1): 1-15.
[http://dx.doi.org/10.1016/j.cger.2010.08.009] [PMID: 21093718]
[20]
Greene M, Covinsky KE, Valcour V, et al. Geriatric syndromes in older HIV-infected adults. J Acquir Immune Defic Syndr 2015; 69(2): 161-7.
[http://dx.doi.org/10.1097/QAI.0000000000000556] [PMID: 26009828]
[21]
Desquilbet L, Jacobson LP, Fried LP, et al. Multicenter AIDS Cohort Study. HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. J Gerontol A Biol Sci Med Sci 2007; 62(11): 1279-86.
[http://dx.doi.org/10.1093/gerona/62.11.1279] [PMID: 18000149]
[22]
Schouten J, Wit FW, Stolte IG, et al. AGEhIV Cohort Study Group. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis 2014; 59(12): 1787-97.
[http://dx.doi.org/10.1093/cid/ciu701] [PMID: 25182245]
[23]
Brothers TD, Kirkland S, Guaraldi G, et al. Frailty in people aging with human immunodeficiency virus (HIV) infection. J Infect Dis 2014; 210(8): 1170-9.
[http://dx.doi.org/10.1093/infdis/jiu258] [PMID: 24903667]
[24]
Levett TJ, Cresswell FV, Malik MA, Fisher M, Wright J. Systematic review of prevalence and predictors of frailty in individuals with human immunodeficiency virus. J Am Geriatr Soc 2016; 64(5): 1006-14.
[http://dx.doi.org/10.1111/jgs.14101] [PMID: 27225356]
[25]
Kooij KW, Wit FWNM, Schouten J, et al. AGEhIV Cohort Study Group. HIV infection is independently associated with frailty in middle-aged HIV type 1-infected individuals compared with similar but uninfected controls. AIDS 2016; 30(2): 241-50.
[http://dx.doi.org/10.1097/QAD.0000000000000910] [PMID: 26684821]
[26]
Shah K, Hilton TN, Myers L, Pinto JF, Luque AE, Hall WJ. A new frailty syndrome: Central obesity and frailty in older adults with the human immunodeficiency virus. J Am Geriatr Soc 2012; 60(3): 545-9.
[http://dx.doi.org/10.1111/j.1532-5415.2011.03819.x] [PMID: 22315957]
[27]
Stanley TL, Grinspoon SK. Body composition and metabolic changes in HIV-infected patients. J Infect Dis 2012; 205(Suppl. 3): S383-90.
[http://dx.doi.org/10.1093/infdis/jis205] [PMID: 22577212]
[28]
McComsey GA, Moser C, Currier J, et al. Body composition changes after initiation of raltegravir or protease inhibitors: ACTG A5260s. Clin Infect Dis 2016; 62(7): 853-62.
[http://dx.doi.org/10.1093/cid/ciw017] [PMID: 26797215]
[29]
Erlandson KM, Wu K, Koletar SL, et al. Association between frailty and components of the frailty phenotype with modifiable risk factors and antiretroviral therapy. J Infect Dis 2017; 215(6): 933-7.
[http://dx.doi.org/10.1093/infdis/jix063] [PMID: 28453849]
[30]
Terzian AS, Holman S, Nathwani N, et al. Women’s Interagency HIV Study. Factors associated with preclinical disability and frailty among HIV-infected and HIV-uninfected women in the era of cART. J Womens Health (Larchmt) 2009; 18(12): 1965-74.
[http://dx.doi.org/10.1089/jwh.2008.1090] [PMID: 20044858]
[31]
Pathai S, Gilbert C, Weiss HA, et al. Frailty in HIV-infected adults in South Africa. J Acquir Immune Defic Syndr 2013; 62(1): 43-51.
[http://dx.doi.org/10.1097/QAI.0b013e318273b631] [PMID: 23018372]
[32]
Desquilbet L, Margolick JB, Fried LP, et al. Multicenter AIDS Cohort Study. Relationship between a frailty-related phenotype and progressive deterioration of the immune system in HIV-infected men. J Acquir Immune Defic Syndr 2009; 50(3): 299-306.
[http://dx.doi.org/10.1097/QAI.0b013e3181945eb0] [PMID: 19194312]
[33]
Desquilbet L, Jacobson LP, Fried LP, Phair JP, Jamieson BD, Holloway M, et al. A frailty-related phenotype before HAART initiation as an independent risk factor for AIDS or death after HAART among HIV-infected men Journals Gerontol - Ser A Biol Sci. Med Sci 2011; 66A(9): 1030-8.
[34]
Guaraldi G, Brothers TD, Zona S, et al. A frailty index predicts survival and incident multimorbidity independent of markers of HIV disease severity. AIDS 2015; 29(13): 1633-41.
[http://dx.doi.org/10.1097/QAD.0000000000000753] [PMID: 26372273]
[35]
UNAIDS. Indonesia [Internet]. UNAIDS 2016.Available from:. https://www.unaids.org/en/regionscountries/countries/indonesia
[36]
Indonesian Health Ministry. Situasi penyakit HIV AIDS di Indonesia [Internet]. Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia 2016; 1-8.Available from:. http://www. depkes.go.id/resources/download/pusdatin/infodatin/infodatin hive aids.pdf
[37]
Pendse R, Gupta S, Yu D, Sarkar S. HIV/AIDS in the South-East Asia region: progress and challenges. J Virus Erad 2016; 2(Suppl. 4): 1-6.
[PMID: 28303199]
[38]
The World Bank. New Country Classifications | Data [Internet] The World Bank Group. 2019. Available from:. http://data.worldbank.org/news/new-country-classifications
[39]
Siriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2018; 8(3)e018195
[http://dx.doi.org/10.1136/bmjopen-2017-018195] [PMID: 29496895]
[40]
Gray WK, Richardson J, McGuire J, et al. Frailty screening in low- and middle-income countries: A systematic review. J Am Geriatr Soc 2016; 64(4): 806-23.
[http://dx.doi.org/10.1111/jgs.14069] [PMID: 27100577]
[41]
Setiati S, Laksmi PW, Aryana IGPS, et al. Frailty state among Indonesian elderly: prevalence, associated factors, and frailty state transition. BMC Geriatr 2019; 19(1): 182.
[http://dx.doi.org/10.1186/s12877-019-1198-8] [PMID: 31269921]
[42]
Beck AT, Steer RA, Brown KG. Manual for the Beck Depression Inventory-IISan Antonio. TX Psychol Corp 1996; 60: 239-51.
[43]
Önen NF, Agbebi A, Shacham E, Stamm KE, Önen AR, Overton ET. Frailty among HIV-infected persons in an urban outpatient care setting. J Infect 2009; 59(5): 346-52.
[http://dx.doi.org/10.1016/j.jinf.2009.08.008] [PMID: 19706308]
[44]
Indonesian Health Ministy. Laporan perkembangan HIV AIDS &infeksi menular seksual tahun 2018 [Internet]. Kementerian Kesehatan Republik Indonesia 2018; 1-158.Available from:. http://siha.depkes.go.id/portal/files_upload/Laporan_Triwulan_IV_2018.pdf
[45]
Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 2004; 52(11): 1929-33.
[http://dx.doi.org/10.1111/j.1532-5415.2004.52521.x] [PMID: 15507074]
[46]
Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr 2008; 8: 24.
[http://dx.doi.org/10.1186/1471-2318-8-24] [PMID: 18826625]
[47]
Richards D. Prevalence and clinical course of depression: a review. Clin Psychol Rev 2011; 31(7): 1117-25.
[http://dx.doi.org/10.1016/j.cpr.2011.07.004] [PMID: 21820991]
[48]
Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L. Depression in HIV infected patients: a review. Curr Psychiatry Rep 2015; 17(1): 530.
[http://dx.doi.org/10.1007/s11920-014-0530-4] [PMID: 25413636]
[49]
Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry 2001; 158(5): 725-30.
[http://dx.doi.org/10.1176/appi.ajp.158.5.725] [PMID: 11329393]
[50]
Arseniou S, Arvaniti A, Samakouri M. HIV infection and depression. Psychiatry Clin Neurosci 2014; 68(2): 96-109.
[http://dx.doi.org/10.1111/pcn.12097] [PMID: 24552630]
[51]
Rees HC, Meister E, Mohler MJ, Klotz SA. HIV-related frailty Is not characterized by sarcopenia. J Int Assoc Provid AIDS Care 2016; 15(2): 131-4.
[http://dx.doi.org/10.1177/2325957414553848] [PMID: 25320145]
[52]
McIntosh RC, Seay JS, Antoni MH, Schneiderman N. Cognitive vulnerability for depression in HIV. J Affect Disord 2013; 150(3): 908-15.
[http://dx.doi.org/10.1016/j.jad.2013.05.014] [PMID: 23726660]
[53]
Watkins CC, Treisman GJ. Cognitive impairment in patients with AIDS - prevalence and severity. HIV AIDS (Auckl) 2015; 7: 35-47.
[http://dx.doi.org/10.2147/HIV.S39665] [PMID: 25678819]
[54]
Bragança M, Palha A. Depression and neurocognitive performance in Portuguese patients infected with HIV. AIDS Behav 2011; 15(8): 1879-87.
[http://dx.doi.org/10.1007/s10461-011-9973-3] [PMID: 21598031]
[55]
Önen NF, Patel P, Baker J, et al. Frailty and pre-frailty in a contemporary cohort of HIV-infected adults. J Frailty Aging 2014; 3(3): 158-65.
[PMID: 27050062]
[56]
Erlandson KM, Perez J, Abdo M, et al. Frailty, neurocognitive impairment, or both in predicting poor health outcomes among adults living with human immunodeficiency virus. Clin Infect Dis 2019; 68(1): 131-8.
[http://dx.doi.org/10.1093/cid/ciy430] [PMID: 29788039]
[57]
Estiasari R, Imran D, Lastri DN, Prawirohardjo P, Price P. Cognitive impairment among Indonesia HIV naïve patients. Neurol Asia 2015; 20(2): 155-60.
[58]
Estiasari R, Aryanto I, Lee S, Pramana S, Djauzi S, Price P. Determinants of cognitive health in Indonesian HIV patients beginning antiretroviral therapy. J Neurovirol 2019. Epub ahead of print
[http://dx.doi.org/10.1007/s13365-019-00787-2] [PMID: 31385196]
[59]
Petit N, Enel P, Ravaux I, et al. Visage group. Frail and pre-frail phenotype is associated with pain in older HIV-infected patients. Medicine (Baltimore) 2018; 97(6)e9852
[http://dx.doi.org/10.1097/MD.0000000000009852] [PMID: 29419697]
[60]
Bartlett JG. Weight loss and wasting in patients infected with human immunodeficiency virus. Infect Dis Clin Pract 2004; 12(2): 128.
[61]
Dudgeon WD, Phillips KD, Carson JA, Brewer RB, Durstine JL, Hand GA. Counteracting muscle wasting in HIV-infected individuals. HIV Med 2006; 7(5): 299-310.
[http://dx.doi.org/10.1111/j.1468-1293.2006.00380.x] [PMID: 16945075]
[62]
McComsey GA, Lo Re V III, O’Riordan M, et al. Effect of reducing the dose of stavudine on body composition, bone density, and markers of mitochondrial toxicity in HIV-infected subjects: a randomized, controlled study. Clin Infect Dis 2008; 46(8): 1290-6.
[http://dx.doi.org/10.1086/529384] [PMID: 18444869]
[63]
Octaviana F, Safri AY, Setiawan DD, et al. Neuropathic pain in HIV patients receiving ART without stavudine in an Indonesia Referral Hospital. J Neurol Sci 2019; 397: 146-9.
[http://dx.doi.org/10.1016/j.jns.2018.12.041] [PMID: 30634130]
[64]
Tang MW, Rhee SY, Bertagnolio S, et al. Nucleoside reverse transcriptase inhibitor resistance mutations associated with first-line stavudine-containing antiretroviral therapy: programmatic implications for countries phasing out stavudine. J Infect Dis 2013; 207(Suppl. 2): S70-7.
[http://dx.doi.org/10.1093/infdis/jit114] [PMID: 23687292]
[65]
Gomes CDS, Guerra RO, Wu YY, et al. Social and economic predictors of worse frailty status occurrence across selected countries in North and South America and Europe. Innov Aging 2018; 2(3)igy037
[http://dx.doi.org/10.1093/geroni/igy037] [PMID: 30569024]
[66]
Lamu AN, Olsen JA. The relative importance of health, income and social relations for subjective well-being: An integrative analysis. Soc Sci Med 2016; 152: 176-85.
[http://dx.doi.org/10.1016/j.socscimed.2016.01.046] [PMID: 26854627]
[67]
Max-Neef M. Economic growth and quality of life: a threshold hypothesis. Ecol Econ 1995; 15(2): 115-8.
[http://dx.doi.org/10.1016/0921-8009(95)00064-X]
[68]
Rizzoli R, Reginster JY, Arnal JF, et al. Quality of life in sarcopenia and frailty. Calcif Tissue Int 2013; 93(2): 101-20.
[http://dx.doi.org/10.1007/s00223-013-9758-y] [PMID: 23828275]
[69]
Bouillon K, Kivimaki M, Hamer M, et al. Measures of frailty in population-based studies: an overview. BMC Geriatr 2013; 13(1): 64.
[http://dx.doi.org/10.1186/1471-2318-13-64] [PMID: 23786540]
[70]
Felce D, Perry J. Quality of life: its definition and measurement. Res Dev Disabil 1995; 16(1): 51-74.
[http://dx.doi.org/10.1016/0891-4222(94)00028-8]

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