title: Frailty, HIV infection, and mortality in an aging cohort of injection drug users.
abstract: BACKGROUND
  Frailty is associated with morbidity and premature mortality among elderly HIV-uninfected adults, but the determinants and consequences of frailty in HIV-infected populations remain unclear. We evaluated the correlates of frailty, and the impact of frailty on mortality in a cohort of aging injection drug users (IDUs).
  
  
  METHODS
  Frailty was assessed using standard criteria among HIV-infected and uninfected IDUs in 6-month intervals from 2005 to 2008. Generalized linear mixed-model analyses assessed correlates of frailty. Cox proportional hazards models estimated risk for all-cause mortality.
  
  
  RESULTS
  Of 1230 participants at baseline, the median age was 48 years and 29% were HIV-infected; the frailty prevalence was 12.3%. In multivariable analysis of 3,365 frailty measures, HIV-infected IDUs had an increased likelihood of frailty (OR, 1.66; 95% CI, 1.24-2.21) compared to HIV-uninfected IDUs; the association was strongest (OR, 2.37; 95% CI, 1.62-3.48) among HIV-infected IDUs with advanced HIV disease (CD4<350 cells/mm3 and detectable HIV RNA). No significant association was seen with less advanced disease. Sociodemographic factors, comorbidity, depressive symptoms, and prescription drug abuse were also independently associated with frailty. Mortality risk was increased with frailty alone (HR 2.63, 95% CI, 1.23-5.66), HIV infection alone (HR 3.29, 95% CI, 1.85-5.88), and being both HIV-infected and frail (HR, 7.06; 95%CI 3.49-14.3).
  
  
  CONCLUSIONS
  Frailty was strongly associated with advanced HIV disease, but IDUs with well-controlled HIV had a similar prevalence to HIV-uninfected IDUs. Frailty was independently associated with mortality, with a marked increase in mortality risk for IDUs with both frailty and HIV infection.
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA. dpiggott@jhsph.edu
authors: Damani A
authors: DA
authors: Piggott
authors: Abimereki D
authors: AD
authors: Muzaale
authors: Shruti H
authors: SH
authors: Mehta
authors: Todd T
authors: TT
authors: Brown
authors: Kushang V
authors: KV
authors: Patel
authors: Sean X
authors: SX
authors: Leng
authors: Gregory D
authors: GD
authors: Kirk
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D001519:Behavior; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000401:mortality*
references: Addiction. 1993 Jun;88(6):791-804
references: 8329970
references: N Engl J Med. 2009 Apr 30;360(18):1815-26
references: 19339714
references: Arch Intern Med. 2007 Jan 22;167(2):166-73
references: 17242318
references: J Am Geriatr Soc. 2007 Jun;55(6):864-71
references: 17537086
references: Lancet. 2010 Jul 31;376(9738):355-66
references: 20650513
references: JAMA. 2008 Aug 6;300(5):550-4
references: 18677027
references: Lancet Infect Dis. 2005 Jul;5(7):407-14
references: 15978527
references: J Gen Intern Med. 2002 May;17(5):377-81
references: 12047736
references: Clin Infect Dis. 2010 Jun 15;50(12):1664-71
references: 20450418
references: Clin Infect Dis. 2011 Mar 15;52(6):793-800
references: 21367734
references: Clin Geriatr Med. 2011 Feb;27(1):79-87
references: 21093724
references: N Engl J Med. 1997 Sep 11;337(11):725-33
references: 9287227
references: J Gerontol A Biol Sci Med Sci. 2007 Nov;62(11):1279-86
references: 18000149
references: J Womens Health (Larchmt). 2009 Dec;18(12):1965-74
references: 20044858
references: Mol Aspects Med. 2005 Jun;26(3):181-201
references: 15811434
references: Ageing Res Rev. 2011 Jul;10(3):319-29
references: 21145432
references: N Engl J Med. 2012 Apr 5;366(14):1270-3
references: 22475591
references: Arch Intern Med. 2008 Feb 25;168(4):382-9
references: 18299493
references: BMC Public Health. 2007 Aug 17;7:212
references: 17705867
references: J Gerontol A Biol Sci Med Sci. 2013 Jan;68(1):62-7
references: 22511289
references: J Infect. 2009 Nov;59(5):346-52
references: 19706308
references: Am J Epidemiol. 1977 Sep;106(3):203-14
references: 900119
references: Sex Transm Infect. 2006 Jun;82 Suppl 3:iii56-63
references: 16735295
references: J Acquir Immune Defic Syndr. 2012 Jul 1;60 Suppl 1:S1-18
references: 22688010
references: J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):255-63
references: 15031310
references: J Epidemiol Community Health. 2010 Jan;64(1):63-7
references: 19692719
references: Clin Infect Dis. 2009 Nov 15;49(10):1570-8
references: 19845472
references: Am J Epidemiol. 2005 Jun 1;161(11):999-1012
references: 15901620
references: Brain Behav Immun. 2011 Oct;25(7):1468-74
references: 21672624
references: Arch Intern Med. 2002 Nov 11;162(20):2333-41
references: 12418947
references: Ann Intern Med. 2001 Jul 3;135(1):17-26
references: 11434728
references: CMAJ. 2011 May 17;183(8):E487-94
references: 21540166
references: Clin Geriatr Med. 2011 Feb;27(1):1-15
references: 21093718
references: J Acquir Immune Defic Syndr. 2009 Apr 1;50(4):360-6
references: 19214124
references: J Gerontol A Biol Sci Med Sci. 2006 Mar;61(3):262-6
references: 16567375
references: J Acquir Immune Defic Syndr. 2003 Jun 1;33 Suppl 2:S76-83
references: 12853856
references: JAMA. 1998 Nov 4;280(17):1497-503
references: 9809730
references: Addict Behav. 2011 Dec;36(12):1282-7
references: 21868170
references: Annu Rev Med. 2011;62:141-55
references: 21090961
references: J Gerontol A Biol Sci Med Sci. 2011 Sep;66(9):1030-8
references: 21719610
references: Addict Behav. 1982;7(4):363-71
references: 7183189
references: JAMA. 1998 Aug 12;280(6):544-6
references: 9707145
references: Lancet. 2010 Mar 20;375(9719):1014-28
references: 20189638
references: Ann Intern Med. 2007 Jan 16;146(2):87-95
references: 17227932
references: J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
references: 11253156
references: Clin Infect Dis. 2011 Dec;53(12):1256-64
references: 21976463
references: Clin Infect Dis. 2007 Jun 1;44(11):1493-9
references: 17479948
references: Clin Infect Dis. 2005 Sep 15;41(6):864-72
references: 16107987
references: NIDA Res Monogr. 1991;109:75-100
references: 1661376
references: Curr Infect Dis Rep. 2008 Sep;10(5):432-8
references: 18687208
references: J Gerontol A Biol Sci Med Sci. 2006 Mar;61(3):284-90
references: 16567379