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Title: Frailty prevalence and predictors in older adults with HIV
Author: Levett, Thomas
ISNI:       0000 0004 7427 0716
Awarding Body: University of Brighton
Current Institution: University of Brighton
Date of Award: 2017
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Background: Advances in HIV management have resulted in life expectancy gains and consequent ageing in people living with HIV (PLWH). Frailty represents a state of vulnerability to stressor events and is associated with adverse outcomes. Frailty has been demonstrated in PLWH at earlier ages and in higher prevalence than HIV-negative cohorts. A comprehensive evaluation of frailty and frailty correlates is lacking in a UK based HIV cohort. Aims: To establish frailty prevalence for a cohort of older adults with HIV in Sussex, and describe associations between frailty and sarcopenia and potential biological, psychosocial and cognitive predictors. Methods: 253 participants aged ≥50 (median 59.6) were recruited between October 2014-October 2015. Frailty was defined by modified Fried frailty phenotype including five criteria: exhaustion, low activity, weight loss, weak grip and slow walking speed. Presence of ≥3 denoted frailty, 1-2 pre-frailty and 0 robust. Associations with frailty were evaluated from demographic, clinical, psychosocial, neurocognitive and functional parameters. A subgroup of 108 underwent DXA scanning to assess for the presence of sarcopenia. Results: 48/253 met frailty criteria, giving a prevalence of 19% (95% CI 14.6- 24.3). A further 111/253 (43.9%) were prefrail and 94/253 (37.1%) robust. Frailty was associated with increasing age, number of comorbidities and worsening mood symptoms, but not HIV factors. Additional correlates with frailty included financial insecurity, smoking, number of non-antiretroviral medications, chronic pain, low physical activity, and elevated IL-6. In the DXA subgroup, low muscle mass was common at 50% with 20% meeting criteria for sarcopenia, which was associated with increased odds of frailty. Negative psychosocial resources and poorer cognitive performance were associated with frailty, with positive psychological traits potentially buffering against higher frailty states. Conclusion: Frailty is common and occurs prematurely in older adults with HIV. Frailty was associated with predictors across biological, psychological and social parameters, suggesting a need to shift emphasis away from a purely biomedical approach to frailty in PLWH.
Supervisor: Wright, Juliet Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available