HIV感染者でもろさを測定する。虚弱患者の同定は、もろさの改善と逆転への第一歩です。
Summary
Frailty syndrome is commonly seen in the aged and reflects multi-system physiological change. However, with reduced functional reserve and resilience frailty is also known to be common in the HIV infected population. This study outlined an easily administered screening test to identify HIV patients with frailty. When significant components of frailty are identified, clinicians will be able to focus on amelioration of the problem and promote reversion to the pre-frail state.
Abstract
一連のテストで構成されるシンプルな、検証プロトコルは、もろさ症候群の高齢患者を識別するために利用可能です。ストレッサーに減少リザーブと抵抗のこの症候群は、加齢と共に発生率が増加します。高齢者では、もろさが虚弱にプレ虚弱への非虚弱から機能の段階的な損失を追求することがあります。私たちは、HIV感染患者における虚弱を学び、〜20％が高齢者1,2のために開発され厳しい基準を使用してフライド表現型を使用して虚弱であることがわかった。 HIV感染で症候群は若い年齢で発生します。
HIV患者1のためにチェックした）意図しない体重減少、歩行速度によって決定されるように2）遅;握力計によって測定された3）弱さ、4）抑うつ尺度に対する回答によって枯渇、および5）、低身体活動を評価することにより決定したキロカロリーは、週の時間に費やされる。プリもろさは、任意の2つの5の基準に存在し、任意の3の場合、もろさは存在していた5つの基準は、異常だった。
テストが完了するまで約10〜15分を取ると、それらはルーチン通院中医療助手によって行うことができる。試験結果は標準テーブルを参照することによって得点される。個々の患者でのもろさに寄与する5要素の理解は、臨床医が関連する根本的な問題に対処できるようにすることができ、それらの多くは、日常のHIVクリニックの訪問で明白ではありません。
Introduction
より多くの米国におけるHIV-1感染者の半数以上が2015年までに50歳以上になると疾病管理プロジェクトのためのセンター。 HIV-1感染患者の増加寿命は罹患率と死亡率のリスクが高いHIV陽性の長老を配置、老化関連の併存疾患の予想外の増加をもたらした。これの一つの重要な例は、HIV-1に感染した成人の促進老化に重要な役割を果たしている可能性弱の新しく記載症候群、となっています。3-7
もろさは、生理的システムの累積下落に起因するストレスの減少リザーブと抵抗の生物学的症候群として、高齢者に定義されており、頻繁に時間をかけて段階的に機能低下に進行されています。もろさの臨床的重要性症候群は、このような機能低下や可動性などの有害健康影響の予測、リスクの高い状態、hospitalizatとみなされていることです過去10年間でイオンと死。8多くの研究では、異なる集団のもろさを評価しようとしています。揚げらは 。もろさの2彼らの定義は高齢女性の研究で検証されました。心血管研究に登録した65歳以上年上の男性と女性のもろさを学び、その定義の9修正は含めて他の研究で使用されているHIV-1感染者。4-7フライドらはさえ障害や併存疾患のない状態で、65歳以上の高齢者人口の7％よりも20から26パーセント古いのに対し、虚弱であることを示したことを虚弱表現型を説明80歳虚弱だった。2弱さが主な知見だけでなく、悪性腫瘍、アテローム性動脈硬化症、感染症（HIV）、またはうつ病のような急性のイベントや併存疾患の結果として二次診断をすることができます10また、おそらく他の因子HIV患者、例えば、静脈内薬物乱用で虚弱に貢献貧困と精神疾患。
もろさは、より深刻なHIV感染症と頻繁に現在4古いHIV-1感染者は、非HIV感染患者よりも若い年齢でのHIV-1感染患者で発見され、彼らが診断されないことが多いので、若い人より短い生存期間を持っていました病気の過程において非常に遅くまで。11もう一つの理由は、高齢の患者は、HIV-1と相互作用する多くの併存疾患を持っているかもしれない。年長のHIV-1感染患者は、HIV-1感染せず同年代の対照個体よりもfrailerとして記載されている。4
枯渇した埋蔵量が臨界に到達する前に弱さは、その初期の段階（ 例えば介入体調不良、タンパク質エネルギー栄養失調、うつ病、ビタミンD欠乏症と他のもろさ関連する条件を逆にする）で可逆的でありますようにHIV-1感染患者における虚弱の臨床測定は重要です。につながるしきい不可逆的な脆弱性と機能低下。
Protocol
Representative Results
Discussion
Previous studies of HIV and frailty: Two retrospective studies by Desquilbet et al. assessed frailty in a cohort of men who have sex with men from the Multicenter AIDS Cohort Studies (MACS). Both studies used a shortened definition of frailty containing fewer criteria than did our study. The first study compared frailty in HIV-1 infected men in the pre-treatment era to a control group of HIV uninfected men.4 There were similar rates of frailty in HIV+ men older than 55 years and HIV- men older than 65 years; frailty was found to occur earlier in HIV-1 infected men. Our study had similar findings of an earlier occurrence of frailty phenotype, but we obtained higher rates of frailty compared with MACS, possibly because our use of the full Fried frailty criteria versus surrogate administrative data, but also because of the different population of patients in our study.
Another study by Desquilbet et al. evaluated CD4 cell count and HIV viral load as predictors of frailty in HIV+ men and found that lower CD4 cell counts and viral loads of more than 50,000 copies of RNA were significantly associated with frailty.5 Also the prevalence of frailty declined in the era of ART. Despite differences in measuring frailty and in population characteristics our study concluded like Desquilbet et al. that a low CD4 cell count is significantly associated with frailty and that patients on long-term ART have less likelihood of developing frailty.1 Premature occurrence of prevalence of frailty, shorter duration of ART, more co-morbidities and lower CD4 count were associated with frailty in both studies, but we did not find a strong association between psychiatric diagnosis and frailty. We found a positive relationship between length of ART and not being frail (Figure 1).
Our findings of frailty in HIV patients: Our initial hypothesis that age was not significantly important when measuring frailty of patients with low CD4 cell counts was confirmed. Frailty is likely more causally related to the inflammatory state and profound immunosuppression found in many patients with low CD4 cell counts. Many of these patients had a history of recently treated opportunistic infections. Because of these observations we propose that an active diagnosis of AIDS (CD4 cell count <200 cells/μl) is a significant co-morbidity itself and significantly predisposes patients to being frail. All of our frail patients had at least one co-morbidity besides HIV itself. Our frail patients <50 years had significantly fewer co-morbidities than the frail population >50 years, though in comparison, the younger people had a lower CD4 cell count.
Our other hypothesis was that frailty may be temporary in younger patients with low CD4 cell counts and may revert when CD4 cell counts improve. We were limited by the low number of patients and this hypothesis could not be proven, but it was a likelyexplanation for the small number of patients in which reversal was demonstrated (Table 1). Longer antiretroviral treatment was found to be protective for frailty (Figure 1). This fact on its own would support the recommendations of starting ART at higher CD4 counts and continuing ART without any treatment breaks. We believe that the main reason by which length of ART treatment was shown to be protective for frailty is that patients on long term treatment are more likely to have better control of co-morbidities as well as HIV and less likely to be frail.
In conclusion we have observed an association between low CD4-cell counts and frailty, which is not affected by age, viral load or the presence of co-morbidities. Effective treatment with ART plays a protective role against frailty, reinforcing the importance of effective ART. Early implementation of ART in the care of HIV patients may protect against frailty. Though not tested in our study, future research should address other interventions known to reverse frailty in the aged including treating deconditioning, protein-energy malnutrition, depression, and vitamin D deficiency.
Disclosures
The authors have nothing to disclose.
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