CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts Conclusion: Aging HIV-infected pre-frail and frail individuals are at significantly increased risk of falls. Regular incorporation of frailty assessments or simple evaluations of 4-mwalk or grip strength in the clinical setting may help identify older HIV-infected individuals at increased risk for falls and those who would benefit from falls prevention interventions. 667 PHYSICAL FUNCTION AND INFLAMMATION IN OLDER HIV-INFECTED MEN Hillary McClintic 1 , Matthew Freiberg 2 , Stephen Crystal 3 , David Leaf 4 , Julie A. Womack 5 , Karen Nieves-Lugo 6 , Janet Tate 7 , Kristina Crothers 8 , Amy Justice 7 , Krisann Oursler 9 1 Virginia Tech, Roanoke, VA, USA, 2 Vanderbilt Univ, Nashville, TN, USA, 3 Rutgers, The State Univ of New Jersey, New Brunswick, NJ, USA, 4 VA Greater Los Angeles Hlthcare System, Los Angeles, CA, USA, 5 VA Connecticut Hlthcare System, Branford, CT, USA, 6 The George Washington Univ, Washington, DC, USA, 7 VA Connecticut Hlthcare System, West Haven, CT, USA, 8 Univ of Washington, Seattle, WA, USA, 9 Salem VA Med Cntr, Salem, VA, USA Background: Aging with HIV infection is often characterized by chronic inflammation, multimorbidity, and frailty distinguished in part by decreased physical function. However, the relationship among these factors is not well understood and varies by the measure of function. We previously found in older HIV+ that the six-minute walk distance (6-MWD) correlates with cardiopulmonary fitness and lung function and further, that the survey-based physical health composite score (PCS) predicts mortality independently of comorbidity. Our current objective is to better understand the relationship between physical function and inflammation by comparing the association of the 6-MWD and the PCS with a panel of biomarkers of inflammation. Methods: This is a cross-sectional study of 177 HIV+men enrolled in the Veterans Aging Cohort Study (VACS) without prior diagnosis of cardiovascular disease. The 6-MWD test was performed at least 48 hours from blood sampling for IL-6, hsCRP, TNFα, sTNFrI, and sTNFrII. The physical health composite score (PCS) was derived from SF-12 survey items with a higher number representing better function. The association of 6-MWD and PCS with log transformed level of biomarkers was determined by Spearman’s correlation and age-adjusted linear regression models. Results: The mean (SD) age was 54.5 (7.3) years and 80%were African American race. The mean (SD) 6-MWD was 499 (82) meters, which was 21% lower than age/gender predicted value. The median (IQR) PCS was 49.6 (39.9-54.7). There was a modest correlation between 6-MWD and PCS (ρ= 0.16, p=0.04). Both 6-MWD and PCS correlated with IL-6 and sTNFrI (Table). Only 6-MWD correlated with hsCRP. In age-adjusted linear regression models, the association of 6-MWD and hsCRP was the only relationship that remained significant. A log increase in hsCRP level was associated with a decrease of 16 meters in the 6-MWD with adjustment for age (β= -16.1, 95%CI (-25.4, -6.9)). Conclusion: Decreased ambulatory function and poor self-reported function are associated with elevated levels of biomarkers of inflammation in HIV+ older men. Levels of hsCRP predicted 6-MWD but not PCS, independently of age. While limited in size, our study contributes to a growing literature suggesting that inflammatory processes may play a greater role among those aging with HIV. Further research with longitudinal assessments of objective and precise measures of physical function are warranted. activities of daily living), or mortality were combined. Log binomial models estimated prevalence ratios (PR) for frailty/NCI and ≥1 outcome over 96 weeks. An a priori decision was made to adjust for age as well as variables with the strongest confounding effect. Results: Of the 897 participants with follow-up data (94%) median age at entry was 51 (IQR 46-56) years, 19%were female, 49% Caucasian, median CD4 count was 620 (IQR 453, 821) cells/µL, and 95% had an HIV-1 RNA <200 copies/mL. The majority (80%) of participants had neither frailty nor NCI; 4% had frailty but no NCI, 14% had NCI without frailty, and 2% had frailty and NCI. Forty-one percent had ≥1 outcome: falls (20%), disability (12%), death (1%), falls + disability (6%), and falls +mortality, disability +mortality, or all 3 (<1% each). Outcomes occurred among 76% of those frail without NCI, 48%with NCI only, 88%with frailty + NCI and 36%without frailty/NCI. In models adjusted for age and education, frailty without NCI was associated with 2x the risk of poor outcome (PR 2.0; 95% CI 1.6, 2.4); a strong association was also seen with frailty + NCI (PR 1.8; 95% CI 1.4, 2.4). A weaker association was seen with NCI without frailty (PR 1.2; 95% CI 1.0, 1.5). Similar results were seen when adjusted for insurance status. Conclusion: The presence of frailty, with or without NCI, was associated with a greater risk of falls, disability or death in HIV-infected adults than NCI alone. Although frailty and NCI may involve similar pathologic mechanisms, interventions targeted at reducing and reversing frailty may have greater impact on these outcomes than NCI-specific interventions. 666 FRAILTY STATUS AND RISK OF FALLS IN HIV-INFECTED OLDER ADULTS IN THE ACTG A5322 STUDY Katherine Tassiopoulos 1 , Mona Abdo 1 , Susan L. Koletar 2 , Frank J. Palella 3 , Babafemi Taiwo 3 , Kristine Erlandson 4 , for the A5322 StudyTeam 1 Harvard Univ, Boston, MA, USA, 2 Ohio State Univ, Columbus, OH, USA, 3 Northwestern Univ, Chicago, IL, USA, 4 Univ of Colorado, Aurora, CO, USA Background: Falls are a significant risk factor for morbidity and mortality in the general population. Among HIV-infected individuals, frailty is common, but an understanding of the association between frailty and falls is limited. Methods: AIDS Clinical Trials Group (ACTG) A5322 is a longitudinal cohort study that enrolled 1035 HIV-infected adults ≥40 years to examine the long-term effects of HIV and antiretroviral therapy on the occurrence of clinical events, physical and neurocognitive function, and inflammation and aging. Research visits take place every 6 months and include medical chart abstraction, medication review, physical exams, laboratory tests, repository specimen collection, questionnaires – including a falls interview, and neurocognitive assessments. Participants also complete a frailty assessment (4-meter walk, grip strength, and self-reported weight loss, exhaustion, and low physical activity). Participants meeting ≥3 of 5 criteria are considered frail, 1-2 criteria are pre-frail, and no criteria are non-frail. Multinomial logistic regression was used to assess the association between frailty status at entry and falls (single and recurrent [2+]) over the following year. The individual frailty components of grip and 4-meter walk were also examined. Results: Of 967 individuals, 81%were male, 30% Black and 19% Hispanic. Median (IQR) age was 51 (46, 56) years. Most participants (92%) were virologically suppressed at entry, and median CD4 count was 618 (IQR 451, 821) cells/µL. Six percent were frail, 39% pre-frail, and 55% non-frail; 174 individuals (18%) had ≥ 1 fall, and 7% had 2+ falls. Among persons with 1 or more falls, 21% sought medical attention and 5% had ≥ 1 fracture. In multivariable models, pre-frail individuals were more likely than non-frail to experience 1 fall (OR=1.55; 95% CI=0.97-2.48) and 2+ falls (OR=3.78; 95% CI=1.86-7.69); this association was stronger for frail individuals (1 fall: OR=2.27; 95% CI=0.86-6.01; 2+ falls: OR=18.6; 95% CI=7.60-45.3). Weaker associations were seen with recurrent falls and slow 4-meter walk (OR=2.90; 95% CI=1.57-5.36) and weak grip (OR=3.86; 95% CI=2.25- 6.63).

CROI 2017 288