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Small Difference in Physical Function between Older HIV Positive and Negative People

SUMMARY: Aging HIV positive U.S. veterans had slightly but significantly worse physical function than their HIV negative counterparts, and experienced greater yearly declines, according to study findings reported in the January 2011 issue of AIDS Patient Care and STDs. Differences diminished, however, after controlling for confounding factors such as injection drug use and hepatitis C coinfection, and when comparing people with specific diseases.

By Liz Highleyman

As people with HIV live longer thanks to effective antiretroviral therapy, aging has become a key focus of HIV medicine. A growing body of evidence indicates that HIV positive people have a higher risk of progressive age-related conditions such as cardiovascular disease, osteoporosis, and neurocognitive impairment -- and tend to develop them at younger ages -- but the relation between HIV and physical functioning has not been extensively studied.

To investigate this issue, Krisann Oursler from the University of Maryland School of Medicine and colleagues performed a cross-sectional analysis of physical function in 3227 HIV positive and 3240 HIV negative participants enrolled in the Veterans Aging Cohort Study (VACS-8) during 2002-2006. Most were men and the average age was about 50 years. Poor health predictors (such as smoking and heavy alcohol use) and comorbid conditions were common in both groups.

The researchers asked about areas of physical function ranging from basic activities of daily living (feeding, bathing, dressing) to instrumental activities of daily living (light, moderate, and heavy work), mobility (walking a few steps, walking inside, walking 1 block), and vigorous activity (walking uphill, running, sports). Participants report their current ability to perform each activity. Self-reported physical function correlated with results on a standardized test, the Short Form-12 physical subscale.


Overall, better physical function predicted longer survival.
Across all age groups, decline in physical function per year was greater for HIV positive compared with HIV negative participants -- a small but statistically significant difference.
The physical function of the average 50-year old HIV positive patient was equivalent to that of the average 51.5-year-old HIV negative participant.
When stratifying by age, however, HIV positive people in the youngest group (< 44 years) had better function than HIV negatives, while in the oldest group (> 55 years) they had worse function.
HIV positive people were more likely than HIV negative participants to have certain cofactors for decreased physical function, including injection drug use (34% vs 16%, respectively) and hepatitis C (31% vs 15%, respectively).
After controlling for confounding factors, HIV itself was no longer significantly associated with poorer physical function.
History of cardiovascular disease was a significant predictor of poorer function, with a similar effect in the HIV positive and negative groups.
Among people with chronic pulmonary disease, HIV positive patients fared worse, however, with a 50-year old having physical function equivalent to that of a 68.1-year-old HIV negative person.

Based on these findings, the study authors wrote, "We conclude that age-associated comorbidity affects physical function in HIV-infected patients, and may modify the effect of aging."

"Longitudinal [following over time] research with markers of disease severity is needed to investigate loss of physical function with aging, and to develop age-specific HIV care guidelines," they added.

"Within the limits of a cross-sectional study, the difference in function between younger and older patients was greater in HIV-infected patients compared to the uninfected patients, adjusted for comorbidity," they elaborated in their discussion.

"It should be noted in the younger (age < 44 years) age group that HIV-infected patients reported higher function than uninfected patients," they continued. "Only this age group of HIV-infected patients had similar frequency of exercise compared to the uninfected patients. This finding raises the question of the role of physical inactivity in worse physical function among older HIV-infected patients.

Investigator affiliations: University of Maryland School of Medicine, Veterans Affairs Maryland Healthcare System, Baltimore, MD; Yale University School of Medicine and Public Health, Veterans Affairs Connecticut Healthcare System, West Haven, CT; Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Rutgers University, New Brunswick, NJ; University of Washington, Seattle, WA; University of Pittsburgh School of Medicine, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Michael E. DeBakey VA Medical Center, Department of Medicine, Baylor College of Medicine, Houston, TX; UCLA School of Medicine, Greater Los Angeles Veterans Affairs Healthcare System Los Angeles, CA; Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and
Clinical Center, Baltimore, MD.


KK Oursler, JL Goulet, S Crystal, and others. Association of Age and Comorbidity with Physical Function in HIV-Infected and Uninfected Patients: Results from the Veterans Aging Cohort Study 25(10): 13-20 (Abstract). January 2011.




















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