title: Disability Among Middle-Aged and Older Persons With Human Immunodeficiency Virus Infection.
abstract: BACKGROUND
  Older human immunodeficiency virus (HIV)-infected adults may experience higher rates of frailty and disability than the general population. Improved understanding of the prevalence, risk factors, and types of impairment can better inform providers and the healthcare system.
  
  
  METHODS
  HIV-infected participants within the AIDS Clinical Trials Group A5322 HAILO study self-reported disability by the Lawton-Brody Instrumental Activities of Daily Living (IADL) Questionnaire. Frailty was measured by 4-m walk time, grip strength, self-reported weight loss, exhaustion, and low activity. Logistic regression models identified characteristics associated with any IADL impairment. Agreement between IADL impairment and frailty was assessed using the weighted kappa statistic.
  
  
  RESULTS
  Of 1015 participants, the median age was 51 years, 15% were aged ≥60 years, 19% were female, 29% black, and 20% Hispanic. At least 1 IADL impairment was reported in 18% of participants, most commonly with housekeeping (48%) and transportation (36%) and least commonly with medication management (5%). In multivariable models, greater disability was significantly associated with neurocognitive impairment, lower education, Medicare/Medicaid insurance (vs private/other coverage), smoking, and low physical activity. Although a greater proportion of frail participants had IADL impairment (52%) compared to non-frail (11%) persons, agreement was poor (weighted kappa <0.18, 95% confidence interval, 0.13, 0.23).
  
  
  CONCLUSIONS
  IADL disability occurs frequently among middle-aged and older HIV-infected adults on effective antiretroviral therapy. Potentially modifiable risk factors (smoking, physical activity) provide targets for interventions to maintain independent living. Systematic recognition of persons at greater risk for disability can facilitate connection to resources that may help preserve independence.
authors.affiliation: Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora.
authors.forename: Nikolas A
authors.initials: NA
authors.lastname: Johs
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Kunling
authors.initials: K
authors.lastname: Wu
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Katherine
authors.initials: K
authors.lastname: Tassiopoulos
authors.affiliation: Department of Internal Medicine, Ohio State University, Columbus.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Koletar
authors.affiliation: Department of Medicine, MetroHealth and Louis Stokes Cleveland Veterans Administration Medical Center, Ohio.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kalayjian
authors.affiliation: Department of Neurosciences, University of California-San Diego.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ellis
authors.affiliation: Department of Medicine,Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Babafemi
authors.initials: B
authors.lastname: Taiwo
authors.affiliation: Department of Medicine,Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Palella
authors.affiliation: Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Erlandson
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D000073496:Frailty; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: HIV; disability; frailty; neurocognitive impairment; physical activity