title: Comparison of functional status instruments in HIV-infected adults on effective antiretroviral therapy.
abstract: BACKGROUND
  The best method for assessment of functional status in human immunodeficiency virus type 1 (HIV-1) infected persons is unknown.
  
  
  OBJECTIVE
  We hypothesized that 3 instruments to assess frailty or disability in elderly populations would perform similarly in HIV-1-infected persons.
  
  
  METHODS
  HIV-infected subjects 45 to 65 years old with plasma HIV-1 RNA <48 copies/mL were classified prospectively as low, moderate, or high function by Fried's frailty phenotype (FFP), the Short Physical Performance Battery (SPPB), and 400-m walk test. Functional instrument agreement was evaluated by weighted kappa statistic, and relationships with demographic or clinical factors were evaluated by odds ratios (OR).
  
  
  RESULTS
  There were 359 participants (85% male, mean age 52 years, mean CD4+ lymphocyte count 551 cells/µL) who were evaluated. Three percent to 8% were low, 31% to 51% were moderate, and 42% to 62% were high function. FFP, SPPB, and 400-m walk test had moderate agreement for functional classification (61%-64%; κ = 0.34-0.41). Across instruments, lower reported physical activity (OR ≯ 5.5; P ≤ .005), no current employment (OR ≯ 4.2; P < .02), arthritis (OR ≯ 6.5; P < .02), neurologic disease (OR ≯ 2.6; P < .05), debilitating pain (OR ≯ 5.4; P < .008), psychiatric disease (OR ≯3.1; P < .03), more comorbidities (OR ≯ 3.6; P ≤ .005), and more non-antiretroviral therapy medications (OR ≯ 3.5; P ≤ .01) were associated with lower function. Current CD4 <200 cells/µL was more likely among low-function (11%) than high-function (2%) persons on FFP (P = .04); other HIV-related characteristics were not significantly different (P > .05) between functional categories on any instrument.
  
  
  CONCLUSIONS
  Moderate functional impairment is common among middle-aged HIV-infected persons, with similar frequencies of impairment detected by 3 instruments. Reduction in comorbid disease, increased physical activity, and improved pain symptom management could reduce functional impairment among persons aging with HIV-infection.
authors.affiliation: Department of Medicine, University of Colorado, Denver, CO, USA. Erlandson@ucdenver.edu
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Erlandson
authors.forename: Amanda A
authors.initials: AA
authors.lastname: Allshouse
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Jankowski
authors.forename: Syki
authors.initials: S
authors.lastname: Duong
authors.forename: Samantha
authors.initials: S
authors.lastname: Mawhinney
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Kohrt
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000503:physiopathology*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011446:Prospective Studies
chemical_list: D019380:Anti-HIV Agents