A previous cross-sectional analysis of 2028 women in the Women’s Interagency HIV Study (WIHS), who were on average 39 years old, found a frailty prevalence of 17% and 10% in women with or at risk for HIV, respectively [1]. To our knowledge, the only two longitudinal studies of frailty among people with HIV were conducted in the Multicenter AIDS Cohort Study (MACS), which includes only men [2,3]. Data on the distribution of frailty components are limited, and have not been reported for HIV-seropositive people in the United State

Adimora, A.A.

Bolivar, H.

Cohen, M.

Cole, S.R.

Edmonds, A.

Edwards, J.K.

Fatukasi, T.V.

Fischl, M.A.

Gange, S.

Gustafson, D.R.

Konkle-Parker, D.

Moran, C.A.

Plankey, M.

Sharma, A.

Tien, P.C.

AIDS

English

Fatukasi, Terra V

Edmonds, Andrew

Gustafson, Deborah R

Cole, Stephen R

Edwards, Jessie K

Bolivar, Hector

Cohen, Mardge

Fischl, Margaret A

Gange, Stephen

Konkle-Parker, Deborah

Moran, Caitlin A

Plankey, Michael

Sharma, Anjali

Tien, Phyllis C

Adimora, Adaora A

University of Miami: Scholarship Miami

Prevalence and 1-year incidence of frailty among women with and without HIV in the Women's Interagency HIV Study

Carolina Digital Repository

CorrespondenceAIDS 2019, 33:357–361Prevalence and 1-year incidence of frailty among women with and without HIV in the Women’s InteragencyHIV StudyA previous cross-sectional analysis of 2028 women in theWomen’s Interagency HIV Study (WIHS), who were onaverage 39 years old, found a frailty prevalence of 17% and10% in women with or at risk for HIV, respectively [1]. Toour knowledge, the only two longitudinal studies offrailty among people with HIV were conducted in theMulticenter AIDS Cohort Study (MACS), whichincludes only men [2,3]. Data on the distribution offrailty components are limited, and have not beenreported for HIV-seropositive people in the United States[4–7].The current analysis included data from eight WIHS siteslocated in Brooklyn, New York; San Francisco,California; Chicago, Illinois; Washington, DC; Atlanta,Georgia; Chapel Hill, North Carolina; Miami, Florida;and Birmingham, Alabama/Jackson, Mississippi [8–10].Institutional review board approval was obtained at eachsite and written informed consent was obtained from allwomen. The study sample included 1404 women aged atleast 40 years old who had at least one frailty assessmentbetween 1 October 2015 and 30 September 2017. Of the1404 women, 424 had frailty assessments taken at bothbaseline and approximately a 1-year period of follow-up;46 women were excluded because of frail status at baselineand 378 women were included in analyses estimating the1-year risk of frailty.Since 1 October 2015, the WIHS protocol has includedthe measurement of frailty components and determinedfrailty status among women aged at least 40 years old. TheFried Frailty Index, a tool validated in the CardiovascularHealth Study, was used to operationalize the frailtyphenotype based on five components: weakness, slow-ness, unintentional weight loss, low activity, andexhaustion [4]. Frail, prefrail, and robust statuses weredefined as exceeding the component-specific thresholdfor at least three frailty components, two frailtycomponents, and one or less frailty component,respectively [4]. We used the cut-off points for walkingspeed and grip strength validated by Fried, unlikeprevious analyses, which used the highest and lowestquintiles of the distributions from their HIV-seronegativepopulations [1–4].The median age was 52 years [interquartile range (IQR):47–57] for both women with HIV (n¼ 1025) andwithout HIV (n¼ 379). Most women were black non-Hispanic [75% (n¼ 1055)], had at least a high schooleducation [70% (n¼ 977)], and had an annual householdincome $18 000 or less [63% (n¼ 876)]. The prevalenceof current smoking [47% (n¼ 177); 38% (n¼ 392)],weekly alcohol consumption greater than seven drinks[19% (n¼ 73); 6% (n¼ 65)], and other substance use [34%(n¼ 128); 25% (n¼ 252)] was higher among womenwithout HIV than among women with HIV. Amongwomen with HIV, 71% (n¼ 732) had an undetectableviral load.The overall prevalence of frailty was 11.5% (n¼ 161/1404); 10.0% (n¼ 103/1025) among women with HIVand 15.3% among women without HIV (n¼ 58/379).Frailty prevalence was higher for women without HIVcompared with women with HIV for all age groupsexcept 55–59 years (Fig. 1a). Low physical activity wasthe most frequently occurring frailty component(Fig. 1b). The prevalence of frailty components wassimilar for women with and without HIV, except that itwas more common for women with HIV to reportunintentional weight loss and for women without HIV tomeet the definition for weakness for each frailty category(Fig. 1b). The most common combinations of frailtycomponents were similar in women with and withoutHIVand included low physical activity and exhaustion forprefrail women [67% (n¼ 252)], and these components incombination with one other component for frail women[68% (n¼ 110)]. The prevalence of current smoking[41% (n¼ 41); 41% (n¼ 113)], weekly alcohol consump-tion greater than seven drinks [18% (n¼ 18); 9%(n¼ 26)], and other substance use [31% (n¼ 31); 22%(n¼ 60)] was more balanced between women withoutHIV (n¼ 101) and women with HIV (n¼ 277) in the risksample compared with the prevalence sample. The overall1-year risk of frailty was 6.6% (95% confidence interval4.1–9.1) and similar for women with [6.5% (n¼ 18)] andwithout HIV [6.9% (n¼ 7)].Previous general population studies suggest that frailty isassociated with older age, female sex, minority race/ethnicity, lower socioeconomic status, geographic loca-tion, comorbidities, poor nutrition, smoking, andpossibly alcohol consumption [1,4,11–14]. To ensurecomparability to HIV-seropositive women, the WIHSpreferentially recruited HIV-seronegative women withcharacteristics that are associated with an increased risk ofHIV infection, such as injection drug use [9]. Several ofthese risk characteristics are highly prevalent in the WIHSpopulation [10]; some were more prevalent amongwomen without HIV in our sample. Our findings suggestthat social and behavioral risk factors could play a pivotalrole in frailty occurrence among HIV-seropositivewomen with or those who are seronegative but at riskfor HIV infection. Future studies should investigatemodifiable risk factors to reduce the burden of frailtyamong women with and without HIV, who arevulnerable to frailty at ages even younger than 65 years.AcknowledgementsThe Women’s Interagency HIV Study (WIHS) is fundedprimarily by the National Institute of Allergy andInfectious Diseases (NIAID), with additional co-fundingfrom the Eunice Kennedy Shriver National Institute ofChild Health and Human Development (NICHD), theNational Cancer Institute (NCI), the National Instituteon Drug Abuse (NIDA), and the National Institute onMental Health (NIMH). Targeted supplemental fundingfor specific projects is also provided by the NationalInstitute of Dental and Craniofacial Research (NIDCR),the National Institute on Alcohol Abuse and Alcoholism(NIAAA), the National Institute on Deafness and otherCommunication Disorders (NIDCD), and the NIHOffice of Research on Women’s Health. Data in thismanuscript were collected by the Women’s InteragencyHIV Study (WIHS). WIHS (Principal Investigators):UAB-MS WIHS (Mirjam-Colette Kempf and DeborahFig. 1. Prevalence of frailty (a) and distribution of frailty components (b) in the Women’s Interagency HIV Study by Frailty Statusand HIV Status 2015–2017 (n U 1404). The height of each bar represents the percentage of participants reporting each frailtycomponent and the value above each bar represents the number of participants.Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighov-werha Ofotokun and Gina Wingood), U01-AI-103408;Bronx WIHS (Kathryn Anastos and Anjali Sharma),U01-AI-035004; Brooklyn WIHS (Howard Minkoff andDeborah Gustafson), U01-AI-031834; Chicago WIHS(Mardge Cohen and Audrey French), U01-AI-034993;Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and LisaMetsch), U01-AI-103397; UNC WIHS (Adaora Adi-mora), U01-AI-103390; Connie Wofsy Women’s HIVStudy, Northern California (Ruth Greenblatt, BradleyAouizerat, and Phyllis Tien), U01-AI-034989; WIHSData Management and Analysis Center (Stephen Gangeand Elizabeth Golub), U01-AI-042590. WIHS datacollection is also supported by UL1-TR000004 (UCSFCTSA), UL1-TR000454 (Atlanta CTSA), and P30-AI-050410 (UNC CFAR). The contents of this publicationare solely the responsibility of the authors and do notrepresent the official views of the National Institutes ofHealth (NIH).Conflicts of interestThere are no conflicts of interest.Terra V. Fatukasia, Andrew Edmondsa, Deborah R.Gustafsonb, Stephen R. Colea, Jessie K. Edwardsa,Hector Bolivarc, Mardge Cohend, Margaret A. Fischle,Stephen Gangef, Deborah Konkle-Parkerg, Caitlin A.Moranh, Michael Plankeyi, Anjali Sharmaj, Phyllis C.Tienk and Adaora A. Adimoraa,l, aDepartment ofEpidemiology, The University of North Carolina atChapel Hill, Chapel Hill, North Carolina, bDepartmentof Neurology, State University of New York-DownstateMedical Center, Brooklyn, New York, cDivision ofInfectious Diseases, Department of Medicine, Univer-sity of Miami Miller School of Medicine, Miami,Florida, dDepartment of Medicine, Stroger Hospitaland Rush Medical Center, Chicago, Illinois, eDivisionof Infectious Diseases, Department of Medicine,University of Miami Miller School of Medicine, Miami,Florida, fDepartment of Epidemiology, Johns HopkinsBloomberg School of Public Health, Baltimore, Mary-land, gDivision of Infectious Diseases, University ofMississippi Medical Center, Jackson, Mississippi, hDivi-sion of Infectious Diseases, Department of Medicine,Emory University School of Medicine, Atlanta, Geor-gia, iDivision of Infectious Diseases, Department ofMedicine, Georgetown University Medical Center,Washington, District of Columbia, jDepartment ofMedicine, Albert Einstein College of Medicine, Bronx,New York, kDepartment of Medicine, University ofCalifornia San Francisco and Department of VeteransAffairs Medical Center, San Francisco, California, andlDivision of Infectious Diseases, Department of Med-icine, The University of North Carolina at Chapel Hill,Chapel Hill, North Carolina, USA.Correspondence to Terra V. Fatukasi, PhD, Depart-ment of Epidemiology, UNC School of Global PublicHealth, 2101 McGavran-Greenberg Hall, PittsboroStreet, CB#7435, Chapel Hill, NC 27599-7435, USA.E-mail: tvmack@live.unc.eduReceived: 2 May 2018; accepted: 14 September 2018.References1. Gustafson DR, Shi Q, Thurn M, Holman S, Minkoff H, Cohen M,et al. Frailty and constellations of factors in aging HIV-infectedand uninfected women–the women’s interagency HIV Study.J Frailty Aging 2016; 5:43–48.2. Desquilbet L, Jacobson LP, Fried LP, Phair JP, Jamieson BD,Holloway M, et al. HIV-1 infection is associated with an earlieroccurrence of a phenotype related to frailty. J Gerontol A BiolSci Med Sci 2007; 62:1279–1286.3. Althoff KN, Jacobson LP, Cranston RD, Detels R, Phair JP, Li X,et al., Multicenter AIDS Cohort Study (MACS). Age, comorbid-ities, and AIDS predict a frailty phenotype in men whohave sex with men. J Gerontol A Biol Sci Med Sci 2014;69A:189–198.4. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C,Gottdiener J, et al. Frailty in older adults: evidence for aphenotype. J Gerontol A Biol Sci Med Sci 2001; 56:M146–M156.5. Cameron ID, Fairhall N, Langron C, Lockwood K, Monaghan N,Aggar C, et al. A multifactorial interdisciplinary interventionreduces frailty in older people: randomized trial. BMC Med2013; 11:65.6. Kooij KW, Wit FW, Schouten J, van der Valk M, Godfried MH,Stolte IG, et al., AGEhIV Cohort Study Group. HIV infection isindependently associated with frailty in middle-aged HIV type1-infected individuals compared with similar but uninfectedcontrols. AIDS 2016; 30:241–250.7. Bregigeon S, Galinier A, Zaegel-Faucher O, Cano CE, Obry V,Laroche H, et al. Frailty in HIV infected people: a new riskfactor for bone mineral density loss. AIDS 2017; 31:1573–1577.8. Barkan SE, Melnick SL, Preston-Martin S, Weber K, Kalish LA,Miotti P, et al. The Women’s Interagency HIV Study. WIHSCollaborative Study Group. Epidemiology 1998; 9:117–125.9. Bacon MC, von Wyl V, Alden C, Sharp G, Robison E, Hessol N,et al. The Women’s Interagency HIV Study: an observationalcohort brings clinical sciences to the bench. Clin Diagn LabImmunol 2005; 12:1013–1019.10. Adimora AA, Ramirez C, Benning L, Greenblatt RM, Kempf M-C, Tien PC, et al. Cohort profile: the Women’s Interagency HIVStudy (WIHS). Int J Epidemiol 2018; 47:393i–394i.11. Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB,Brunner RL, et al., Women’s Health Initiative. Frailty: emer-gence and consequences in women aged 65 and older in theWomen’s Health Initiative Observational Study. J Am GeriatrSoc 2005; 53:1321–1330.12. Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR,Varadhan R, et al. Frailty in older adults: a nationally repre-sentative profile in the United States. J Gerontol A Biol Sci MedSci 2015; 70:1427–1434.13. Terzian AS, Holman S, Nathwani N, Robison E, Weber K, YoungM, et al., Women’s Interagency HIV Study. 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Prevalence and 1-year incidence of frailty among women with and without HIV in the Women's Interagency HIV Study

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