title: Association of chronic obstructive pulmonary disease with frailty measurements in HIV-infected and uninfected Veterans.
abstract: Chronic obstructive pulmonary disease (COPD) prevalence is increasing among aging HIV-infected individuals. We determined the association between COPD and self-reported measures of frailty [adapted frailty-related phenotype (aFRP)] and physical limitation, and a clinical biomarker of physiologic frailty [Veterans Aging Cohort Study (VACS) Index] in HIV-infected compared with uninfected individuals.
  
  
  
  Cross-sectional study of VACS participants between 2002 and 2012.
  
  
  
  Prefrail/aFRP was obtained from self-reported surveys. Prefrail was defined as 1-2 domains of physical shrinking, exhaustion, slowness and low physical activity; aFRP was defined as at least 3 domains. Physical limitation scale was determined from 12 self-reported survey items assessing limitations performing physical activities. VACS index includes age and laboratory measurements. We used regression models to test for associations between COPD and outcomes in models stratified by HIV status.
  
  
  
  The sample included 3538 HIV-infected and 3606 uninfected participants; 67 and 63% were black (P = 0.0003), 97 and 92% were men (P < 0.0001) and 4 and 5% had COPD (P = 0.2). In unadjusted analyses, COPD was associated with all three outcomes (P < 0.0001). In adjusted analyses, COPD was associated with increased prefrail and aFRP in HIV-infected and uninfected participants (P ≤ 0.01 for all comparisons). COPD was associated with physical limitation in both groups (P < 0.0001). There was an interaction between COPD and physical limitation by HIV status with increased physical limitation among HIV-infected participants (P = 0.04). COPD was not associated with VACS index.
  
  
  
  COPD was strongly associated with aFRP and physical limitations. COPD management may mediate frailty through functional limitations rather than physiologic biomarkers, especially in HIV-infected individuals.
authors.affiliation: aDepartment of Internal Medicine, VA Connecticut Healthcare System, West Haven bDepartment of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut cDepartment of Medicine, Salem VA Medical Center dVirginia Tech Carilion SOM, Salem, Virginia eInstitute for Health, Healthcare Policy and Aging Research, Rutgers University, New Brunswick, New Jersey fDepartment of Medicine, VA Greater Los Angeles Healthcare System, U.C.L.A. School of Medicine, Los Angeles, California gYale School of Nursing, New Haven hVA Connecticut Healthcare System, West Haven, Connecticut iDivision of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland jDepartment of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Akgün
authors.forename: Janet P
authors.initials: JP
authors.lastname: Tate
authors.forename: Krisann K
authors.initials: KK
authors.lastname: Oursler
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: David A
authors.initials: DA
authors.lastname: Leaf
authors.forename: Julie A
authors.initials: JA
authors.lastname: Womack
authors.forename: Todd T
authors.initials: TT
authors.lastname: Brown
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D000073496:Frailty; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D014728:Veterans