CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

879

Clinical and Economic Benefits of Preventing Physical Frailty and Falls Among PWH in the US Karen C. Smith 1 , Cathryn Brown 1 , Emily Hyle 2 , Michael Paskewicz 1 , Reyhaneh Zafarnejad 1 , Todd Brown 3 , Kenneth A. Freedberg 2 , Kristine M. Erlandson 4 , Elena Losina 1 1 Brigham and Women's Hospital, Boston, MA, USA, 2 Massachusetts General Hospital, Boston, MA, USA, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4 University of Colorado Anschutz Medical Campus, Aurora, CO, USA Background: Over 50% of people with HIV (PWH) in the United States (US) are older than 50 years and are at risk for a high lifetime burden of physical frailty, falls, and fall-related fractures. However, data on the long-term clinical and economic consequences of these events are sparse. We projected the survival gains and economic benefits of preventing physical frailty, falls, and fall-related fractures among aging PWH in the US. Methods: We developed and validated a microsimulation model (FraPol) to project survival outcomes and costs associated with preventing physical frailty, falls, and fall-related fractures in people with virologically suppressed HIV in the US age 40+ (519,640 people). We used data from HAILO, MACS, WIHS, and published literature to inform model parameters. Fall risk (18% average annual risk) and risk of injury or fracture after a fall (17% and 8%, respectively) were estimated from HAILO. Costs and effects of frailty and fractures on mortality were from published literature. We compared the status quo with three scenarios, removing: (1) physical pre-frailty/frailty, (2) falls without fracture, and (3) fall-related fractures. For each scenario, we calculated survival gains and impact on remaining lifetime frailty-, fall-, and fracture-related costs (non discounted) as the difference in outcomes compared to the status quo. Results: We projected that people with virologically suppressed HIV aged 40+ (mean age 56y) in the US would have a remaining life expectancy of 20.5 years, with an average of 11.8 years, or ~60% of their remaining lifespan, with pre-frailty or frailty. There would be an average of 11.0 lifetime falls and 0.4 fall related fractures per person. Preventing pre-frailty and frailty would increase survival by 5.6 years, on average, and preventing fall-related fractures would increase survival by 0.4 years. Among PWH in the US age 40+, we projected that preventing pre-frailty and frailty would result in 2.9 million life-years gained and $16.2 billion saved. Preventing falls without fracture would save $2.3 billion, and preventing fall-related fractures would result in 221,600 life-years gained and $2.5 billion saved. Conclusions: The burden of frailty, falls, and fall-related fractures among PWH in the US will be substantial. Effective interventions to prevent frailty, falls, and fractures may improve survival, and savings could in part offset other health related spending.

878

Frailty and All-Cause Mortality Among People With HIV Engaged in Clinical Care in the United States Stephanie A. Ruderman 1 , Carolyn A. Fahey 1 , Ryan P. Kyle 1 , Edward Cachay 2 , Joseph A. Delaney 1 , Sonia Napravnik 3 , Allison Webel 1 , Kenneth Mayer 4 , George Yendewa 5 , Lydia N. Drumright 1 , Laura Bamford 6 , Charles Kamen 7 , Michael Saag 8 , Mari Kitahata 1 , Heidi M. Crane 1 , for the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) 1 University of Washington, Seattle, WA, USA, 2 University of California San Diego, La Jolla, CA, USA, 3 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 The Fenway Institute, Boston, MA, USA, 5 Case Western Reserve University, Cleveland, OH, USA, 6 University of California San Diego Medical Center, La Jolla, CA, USA, 7 University of Rochester Medical Center, Rochester, NY, USA, 8 University of Alabama at Birmingham, Birmingham, AL, USA Background: Frailty is an aging-related risk factor for poor outcomes in the general population, conferring up to 2.5 times higher risk of mortality compared with those without frailty. Frailty is a growing concern among people with HIV (PWH) as this population faces chronic immune activation, high rates of comorbidities, and polypharmacy. Frailty in PWH occurs up to a decade earlier than in those without HIV; therefore, it is important to understand the impact of frailty among PWH of all ages. Methods: We assessed frailty status and all-cause mortality among PWH in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort between 1/2015-3/2024. The CNICS data repository harmonizes information on demographic, clinical, and behavioral factors, and self-reported outcomes. Frailty was defined using a validated frailty phenotype of four components (i.e., fatigue, weight loss, activity, mobility). All-cause mortality was ascertained using multiple approaches including state death certificate data and national death indexes. We used Cox proportional hazards models to estimate the association between time-updated frailty status (robust, prefrail, frail) and all-cause mortality. Models were restricted to PWH with complete case data and adjusted for age, sex, race/ethnicity, site, HIV viral load (time-updated), current CD4 count (time-updated), diabetes status, treated dyslipidemia, treated hypertension, hepatitis C virus, hepatitis B virus, liver function (FIB-4), kidney function (eGFR), body mass index, illicit drug use, smoking status, and alcohol use. Results: Among 6,737 PWH at baseline, average age was 50 (SD: 12), 15% were female, 45% were non-Hispanic White, 33% were non-Hispanic Black, 44% were prefrail, and 11% were frail. Over an average of 5.5 years of follow-up (median: 5.8), there were 360 deaths recorded, yielding an incidence rate of 9.7 per 1000 person-years (95% CI: 8.8-10.8). In adjusted models, frailty was associated with 2.48 times greater risk of death (95% CI: 1.85-3.33) and prefrailty was associated with 1.42 times greater risk of death (95% CI: 1.10-1.83). Prefrailty and frailty were consistently associated with an increased risk of death in models stratified by age (<50 vs. ≥50) and sex (male vs. female) (Table). Conclusions: In a large cohort of PWH in care, frailty and prefrailty were associated with a greater risk of death; notably, this was true for PWH under 50. Understanding and preventing frailty in this high-risk population remains a priority.

Poster Abstracts

CROI 2025 271