Impaired physical function in middle-aged
people living with HIV is associated with low muscle mass, reduced bone
mineral density and hormonal changes, according to research conducted in the
United States and published in the online edition of the Journal of Acquired Immune Deficiency Syndromes. These are similar
to the factors associated with frailty among elderly patients in the general
population. The investigators stress the importance of improving muscle and
bone mass and boosting certain hormone levels in people with lower physical
Thanks to antiretroviral therapy, the
prognosis of many people living with HIV is now excellent. Nevertheless, there
is some evidence that people with HIV may experience premature or
accelerated ageing and be vulnerable at an early age to the diseases of old
In the general population, ageing is accompanied
by reductions in muscle mass, accumulation of visceral and subcutaneous fat,
loss of strength and low bone mineral density. Hormonal changes also have a
role in the ageing process, including lower production of insulin-like growth
factor (IGF)-1 and IGF binding protein-3 (IGFBP-3).
Investigators at the University of Colorado
Hospital wanted to assess the relationship between these classic indicators of
ageing and functional capacity in middle-aged people with HIV.
The study involved people aged between 45
and 65 years. All were taking antiretroviral therapy and had a viral load below
A range of tests was used to assess the
physical function of the study participants. The investigators matched 33 people with
low physical function with 48 high-function control patients of the same sex, similar
age and comparable duration of infection with HIV.
Overall, the participants had a mean age of 53
years, mean CD4 cell count was approximately 600 cells/mm3 and 96%
had a viral load below 50 copies/ml.
However, there were significant differences
between those with low physical function and those with higher function.
People with low physical function were more likely to
be smokers (50 vs 12%; p = 0.012) than those with high levels of
physical function. They also had lower nadir (lowest ever) CD4 cell counts (106 vs 179
cells/mm3; p = 0.028), were more likely to report chronic pain (68
vs 8%; p < 0.001) and had a higher VACS Index score (an indicator of poor
prognosis, p = 0.001) than people in the control group.
A fifth of people with low function were
classified as obese, compared to 13% of higher functioning patients. Participants
with low physical function were significantly more likely to have low levels of
lean muscle mass than the control group (OR = 2.5; 95% CI, 1.0-6.1; p = 0.04). A low
body mass index (BMI) was also predictive of poor physical function (OR = 1.7;
95% CI, 1.2-2.2; p < 0.001).
Rates of osteopenia or osteoporosis in the
hip were significantly higher among the people with low physical function
than those with higher functioning (68 vs 33%; p = 0.01). Moreover,
67% of people with low function had reduced bone mineral density in the
lumbar spine compared to 38% of the controls (p = 0.02).
Lower T-scores at the hip (OR = 3.8; 95%
CI, 1.1-12.5; p = 0.028) and lumbar spine (OR. 2.3; 95% CI, 1.1-4.5; p =
0.022), together with lower bone mineral density in the lumbar spine (OR = 2.1;
95% CI, 1.1-4.0; p = 0.023) and hip (OR = 2.4; 95% CI, 1.1-5.6; p = 0.032) were
all significantly associated with low physical function.
The investigators believe these findings
point towards “a significant increase in fracture risk among low functioning
persons.” They stress the importance of “evaluating, monitoring, and modifying
risks for both falls and bone fragility to prevent fractures among persons
ageing with HIV.”
Low function was also associated with
reductions in IGF-1 (OR = 5.0; 95% CI, 1.4-20.00; p = 0.015) and IGFBP-3 (OR =
3.3; 95 CI, 1.7-9.9; p = 0.002).
Indeed, levels of IGF-1 observed in people with low function were similar to those seen in healthy men in the
general population aged between 70 to 80 years, or frail women in their 70s.
“Our findings indicate that functional
impairment in middle-aged adults with HIV-1 infection is associated with low
muscle mass, bone mineral density, IGF-1, and IGFBP-3,” the investigators
conclude. “Further studies should investigate the impact of interventions to
increase bone, muscle, or IGF-1 on functional capacity among persons ageing
with HIV infection.”