Prognostic Factors of Physical Function Decline Among Middle-Aged Adults With HIV

Pitavastatin to REduce Physical Function Impairment and FRailty in HIV (PREPARE) found small declines in physical function overall among people with HIV (PWH). However, there was substantial individual variability. The purpose of this prespecified exploratory analysis was to identify the PWH at greatest risk for physical function decline.

Participant-specific annualized rates of change on annually measured chair rise rate, gait speed, the modified Short Performance Physical Battery (composite of the latter 2 plus balance time), and grip strength were estimated from linear mixed-effect models. Change in performance that was below the 20th percentile of the study population in ≥1 measure was classified as physical function decline. Associations between baseline factors and physical function decline were evaluated with log-binomial regression models.

Of 569 participants (81% male, 52% White), the median age (Q1-Q3) was 51 (47-55) years. Half (52%) of the participants had decline in physical function. The risk of decline was higher among females (relative risk [RR], 1.32; 95% CI, 1.12-1.55) and non-Whites (RR, 1.23; 95% CI, 1.05-1.45) and tended to increase with age (50-55 years: RR, 1.04; 95% CI, 0.86-1.26; 55+ vs 40-<50 years: RR, 1.17; 95% CI, 0.98-1.39). In models adjusted for age, sex, and race, we found greater risk of decline among those with history of depression treatment, higher body mass index (BMI), preexisting functional impairment, frailty (by index), and higher baseline high-sensitivity C-reactive protein and interleukin-6 levels.

PWH with history of depression treatment, high BMI, or levels of inflammation and those showing early signs of functional impairment may be at higher risk of physical function decline and should be targeted for early interventions to preserve physical function with aging.