title: Frailty and Pre-Frailty in a Contemporary Cohort of HIV-Infected Adults.
abstract: OBJECTIVE
  To determine the prevalence of pre-frailty among HIV-infected persons and associations with pre-frailty and frailty in this population.
  
  
  METHODS
  From a contemporary, prospective observational cohort of HIV-infected persons (SUN Study), we determined, using a cross-sectional analytic study design, the proportions of non-frail, pre-frail, and frail persons by the respective presence of 0, 1-2, and ≥ 3 of 5 established frailty criteria: unintentional weight loss, exhaustion, physical-inactivity, weak-grip and slow-walk. We evaluated associations with pre-frailty/frailty using multivariate analysis.
  
  
  RESULTS
  Of 322 participants assessed (79% men, 58% white non-Hispanic, median age 47 years, 95% on combination antiretroviral therapy [cART], median CD4 + cell count 641 cells/mm3 and 93% HIV RNA < 400 copies/mL), 57% were non-frail, 38% pre-frail, and 5% frail. Age increased from non-frailty through frailty. Notably, however, half of pre-frail and frail participants were < 50 years, and of those, 42% and 100%, respectively, were long-term unemployed (versus 16% of non-frail counterparts). In multivariate analysis, pre-frail/frail participants were more likely to have Hepatitis C seropositivity (adjusted odds ratio [aOR] 3.24, 95% CI: 1.35-7.78), a history of AIDS-defining-illness (aOR 3.51, 95% CI: 1.82-6.76), greater depressive symptoms (aOR 1.16, 95% CI:1.09-1.23), higher D-dimer levels (aOR 2.94, 95% CI:1.10-7.87), and were less likely to be white non-Hispanic (aOR 0.35, 95% CI: 0.20-0.61).
  
  
  CONCLUSIONS
  Pre-frailty and frailty are prevalent in the cART era and are associated with unemployment even among persons < 50 years. Pre-frailty appears to be an intermediate state in the spectrum from non-frailty through frailty and our characterization of pre-frailty/frailty suggests complex multifactorial associations.
authors.affiliation: Nur F. Önen, MD, Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Box 8051, 660 S. Euclid Ave, St. Louis, MO, 63110, USA. Phone: 314 454 8225; Fax 314 362 6295; email: nonen@dom.wustl.edu.
authors.forename: N F
authors.initials: NF
authors.lastname: Önen
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.forename: J
authors.initials: J
authors.lastname: Baker
authors.forename: L
authors.initials: L
authors.lastname: Conley
authors.forename: J T
authors.initials: JT
authors.lastname: Brooks
authors.forename: T
authors.initials: T
authors.lastname: Bush
authors.forename: K
authors.initials: K
authors.lastname: Henry
authors.forename: J
authors.initials: J
authors.lastname: Hammer
authors.forename: E M
authors.initials: EM
authors.lastname: Kojic
authors.forename: E T
authors.initials: ET
authors.lastname: Overton