February 13–16, 2017



Frailty has a Stronger Association than Neurocognitive Impairment with Poor Outcomes
CROI | February 13-16, 2017

Mark Mascolini

Frailty and neurocognitive impairment (NCI) each independently predicted falls, disability, and death in an 897-person AIDS Clinical Trials Group (ACTG) cohort [1]. But frailty proved the stronger predictor, about as strong as frailty and NCI combined.

ACTG investigators who conducted this study observe that frailty and NCI are closely related, and their previous work identified NCI as one of the strongest frailty predictors in people with HIV. They conducted the new study to explore associations between frailty and NCI--alone and together--and three serious outcomes: falls, disability, and death.

Study participants were HIV-infected adults 40 or older who received their first antiretroviral regimen in an ACTG trial. Each completed a standard frailty assessment incorporating a 4-meter walk, grip strength, and self-reported weight loss, exhaustion, and low physical activity. Participants completed three neurocognitive tests and researchers used results to define NCI. Every 24 weeks participants reported falls, and every 48 weeks they reported disability (an increase from baseline in 1 or more Instrumental Activities of Daily Living). The investigators tabulated these outcomes and mortality over 96 weeks.

Of the 954 study participants, 44% were 40 to 49, 41% were 50 to 59, and 15% were 60 or older. Most participants, 81%, were men, 49% were white, 31% black, and 20% Hispanic. People had been taking antiretrovirals for a median of 7.7 years, and 76% had a viral load below 200 copies on more than 75% of visits.

Among 897 participants with outcome data, 4% were frail, 14% had NCI, 2% had both frailty and NCI, and 80% had neither. Proportions with at least one of the three outcomes (falls, disability, death) were 28 of 37 (76%) with frailty, 59 of 123 (48%) with NCI, 15 of 17 (88%) with both frailty and NCI, and 261 of 720 (36%) with neither frailty nor NCI.

In an age-adjusted log-binomial model, frailty plus NCI (vs no frailty and no NCI) proved the strongest predictor of the three outcomes (risk ratio [RR] 2.11, 95% confidence interval [CI] 1.70 to 2.60). But frailty alone predicted the three outcomes almost as strongly (RR 1.96, 95% CI 1.59 to 2.41). NCI alone also predicted the three outcomes, but less robustly than frailty alone (RR 1.33, 95% CI 1.09 to 1.61) (P < 0.001 for all associations). Results of an insurance-adjusted analysis were similar. But in an education-adjusted analysis, NCI alone was a stronger outcome predictor (RR 2.14, P < 0.001) than frailty plus NCI (RR 2.09, P < 0.001) or NCI alone (RR 1.24, P = 0.05).

"Although frailty and NCI may share similar pathologic mechanisms," the researchers suggest, "interventions targeted at reducing and reversing frailty may have greater impact on these adverse outcomes than NCI-specific interventions."

Erlandson K, Abdo M, Robertson K, et al. Frailty has a stronger association than neurocognitive impairment with poor outcomes. Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 665.