CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Background: We have previously demonstrated the efficiency of a 12-week multicomponent exercise program (MEP) in reversing frailty, improving physical performance, and preserving muscle mass in older adults with HIV (OAWH). The objective of this study was to analyze the efficacy of this MEP in the long term, after 1 year. Methods: Sedentary adults 50 or over with and without HIV were included in a prospective longitudinal study with 12-, and 48-week follow-up. The intervention was a MEP performed in real-life conditions. Dependent variables were frailty (frailty phenotype), physical function (gait speed, SPPB), physical performance, and anxiety and depression (HADS and Geriatric Depression Scale Short-Form). Pre- and postintervention measurements were analyzed using McNemar's test for categorical variables and the Wilcoxon signed-rank test for quantitative variables. Results: Sixty participants were included: 40 OAWH and 20 older adults without HIV. Median age was 56.5 years. 23.3% were women. The prevalence of frailty was 6.6% with no frail HIV-negative participants. At week 48, 32 participants continued, 21 OAWH and 11 older adults without HIV. The percentage of robustness increased after the MEP from 25.81% to 77.42% (RR 3 [95% CI, 1.7 – 5.2]), the percentage of prefrailty decreased from 64.52% to 22.58% and there were no frail patients at week 48. All participants improved [48-week vs basal] their SPPB score [12 (11-12) vs 11 (10.5-12), p =0.0001], and upper extremity strength [ 17 (15-20) vs 13 (12-15), p = 0.0001]. Anxiety [ 6.5 (4.5-11.5) vs 6 (3-10), p = 0.001] was improved only in the OAWH. In participants with an adherence ≥ 50%, the following were significantly improved [48-week vs basal]: gait speed (m/s) [1.29 (1.51-1.12) vs (1.33-1.02), p =0.02] without differences by HIV status, and aerobic endurance [74 (55-94) vs 61 (52-71), p =0.001] only in the OAWH. In participants with an adherence ≥ 50%, a significant improvement 48-week vs 12-week was found in gait speed [1.29 (1.51-1.12) vs 1.21 (1.39-1.07), p =0.03], upper limb strength [18 (16-21) vs 16.5 (15-19), p =0.003], aerobic endurance [74 (55-94) vs 64 (59-83), p =0.04], and agility [5.77 (5.2-6.7) vs 6.38 (5.7-6.8), p =0.04]. Conclusion: A 48-week MEP improves robustness, physical function, physical performance in older adults independently of HIV status, and anxiety only in OAWH. Continuing the MEP after the first 12 weeks for up to one year produces an even greater improvement in physical function and physical performance. Clonal Hematopoiesis and HIV Infection Are Associated With Geriatric Outcomes: The ARCHIVE Study Win Min Han 1 , Mark Bloch 2 , David A. Baker 3 , Norman Roth 4 , Jennifer F. Hoy 5 , Ian Woolley 6 , Robert Finlayson 7 , Jane Costello 1 , Mark Dawson 8 , Sarah-Jane Dawson 8 , Mark Polizzotto 9 , Kathy Petoumenos 1 , Paul Yeh 6 , Nila J. Dharan 1 , for the ARCHIVE Study Group 1 Kirby Institute, Sydney, Australia, 2 Holdsworth House Medical Group, Sydney, Australia, 3 East Sydney Doctors, Darlinghurst, Australia, 4 Prahran Market Clinic, Melbourne, Australia, 5 Alfred Hospital, Melbourne, Australia, 6 Monash Health, Melbourne, Australia, 7 Taylor Square Private Clinic, Sydney, Australia, 8 Peter MacCallum Cancer Centre, Melbourne, Australia, 9 Australian National University, Canberra, Australia Background: People living with HIV have accelerated biological aging and a higher prevalence of aging-related comorbidities and geriatric outcomes. Clonal hematopoiesis (CH), an aging-related cellular phenomenon that is linked to adverse clinical outcomes, is increased in people living with HIV. Here we evaluated geriatric outcomes in older adults with and without HIV to determine whether HIV or CH is associated with geriatric outcomes. Methods: Participants were enrolled from the ARCHIVE study, a prospective observational cohort of adults with and without HIV >55 years, and evaluated for CH and geriatric outcomes. Frailty was measured by the FRAIL questionnaire, which categorizes individuals as frail, pre-frail and robust. Phenotypic age acceleration (PAA) was defined as the difference between phenotypic age, measured by nine biochemical and blood cell characteristics, and chronological age. Quality of life (QoL) was measured by the CASP-19 scale. Descriptive statistics compared baseline characteristics across HIV status. Multivariable logistic and linear regression was used to evaluate for associations between HIV and CH, and geriatric outcomes. Results: Of 344 participants, 175 had HIV and 169 did not. The median (interquartile range; IQR) age was 67 (62,72) years, 97% identified as male, 61% had a body mass index>25, 41% reported ever smoking, and 54% reported being diagnosed with cardiovascular disease. Overall, 23% had at least one CH mutation (27% of those with HIV and 18% of those without HIV; p=0.045), 7% were frail, the median (IQR) PAA was 0.6 years (-2.5,5.0), and the median (IQR)

QoL score was 36 (29,39) out of 57. Participants with HIV had a median (IQR) duration of HIV of 27 (18,33) years and a median (IQR) CD4 nadir of 246 (143,372) cells/mm 3 ; all but one participant had a suppressed viral load. In adjusted regression analyses (Figure), HIV infection was independently associated with PAA (coefficients 1.73, 95% confidence interval [CI] 0.3-3.16, p=0.02) and CH was independently associated with reduced QoL (coefficients -2.18, CI -3.92, -0.44, p=0.01) and being frail (vs. pre-frail/robust; odds ratio 2.36, CI 1.01-5.63, p=0.049). Conclusion: In the ARCHIVE cohort, HIV was associated with PAA and CH, and CH was associated with frailty and reduced QoL. While our results warrant further exploration, they suggest that CH may be used as a biomarker for geriatric outcomes that may prioritize individuals for interventions designed to reduce geriatric outcomes and promote healthy aging.

Poster Abstracts

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Frailty and Health-Related Quality of Life in an Aging Cohort of People With HIV, 2012-2022 Lydia N Drumright 1 , Bridget Whitney 1 , Crystal Chapman Lambert 2 , Amanda Willig 2 , Robin M. Nance 1 , Stephanie A. Ruderman 1 , Sonia Napravnik 3 , Katerina Christopoulos 4 , Edward Cachay 5 , Lara Haidar 6 , Jimmy Ma 1 , Mari Kitahata 1 , Allison R. Webel 1 , Heidi M. Crane 1 1 University of Washington, Seattle, WA, USA, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 University of California San Francisco, San Francisco, CA, USA, 5 University of California San Diego, La Jolla, CA, USA, 6 University of Manitoba, Winnipeg, Canada Background: Due to advancements in antiretroviral therapy, people with HIV (PWH) are living near normal lifespans, however PWH age more rapidly and experience frailty at an earlier age than the general population. We examined the impact of frailty on quality of life (QoL) over time among PWH. Methods: We assessed changes in QoL and frailty from 2012-2022 among PWH in care at 6 CFAR Network of Integrated Clinical Systems (CNICS) sites. Assessments of QoL, using the EQ-5D visual analog scale, and frailty, using a validated, modified frailty phenotype based on 4 Fried frailty components, were collected at routine clinical visits every ~3-6 months. Linear mixed models were used to assess individual level associations between frailty and QoL over time. Linear regression of mean QoL by frailty category and year was used to assess population level changes. Results: 12,397 PWH with 38,830 frailty assessments were included. At initial frailty assessment, mean age was 45 years, 13% were female, 52% reported non-White race/ethnicity, 41% were robust (i.e., were not frail/prefrail), 45% prefrail, 14% frail, and mean QoL was 73. PWH who were prefrail and frail reported a 10% (95% CI: -10.4, -9.6, p<0.001) and 24% (95% CI: -24.4, -23.0, p<0.001) lower QoL respectively than those who were robust after controlling for age, sex, race/ethnicity, and COVID-era (i.e., March 2020 onward). Overall, we observed an annual increase in QoL of 0.4% until 2020, then a 2% decline during the COVID-era. Similar trends were observed for population level changes in QoL, with prefrail and frail PWH having a lower mean QoL, 13% (95%CI: -14.0,- 11.5; p<0.001) and 31% (95% CI: -32.0,-29.0; p<0.001) respectively compared with robust PWH (Figure). Conclusion: In our study, PWH who were frail and prefrail reported ~30% and ~10% lower QoL respectively than those who were not frail. While QoL among PWH in care in the United States appears to be slowly increasing over time, frailty can have a significant impact on QoL. Minimizing and preventing frailty and addressing comorbidities that contribute to frailty could increase QoL among PWH.

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