Abstract
Although physical function decline is common with aging, the burden of this impairment remains underestimated in patients living with HIV (PLHIV), particularly in the older people receiving antiretroviral treatment (ART) and living in sub-Saharan Africa (SSA). PLHIV aged ≥50 years old and on ART since ≥6 months were included (N = 333) from three clinics (two in Côte d'Ivoire, one in Senegal) participating in the International epidemiological Databases to Evaluate AIDS (IeDEA) West Africa collaboration. Physical function was measured using the Short Physical Performance Battery (SPPB), the unipodal balance test and self-reported questionnaires. Grip strength was also assessed. Logistic regression was used to identify the factors associated with SPPB performance specifically. Median age was 57 (54-61) years, 57.7% were female and 82.7% had an undetectable viral load. The mean SPPB score was 10.2 ±1.8. Almost 30% had low SPPB performance with the 5-sit-to-stand test being the most altered subtest (64%). PLHIV with low SPPB performance also had significantly low performance on the unipodal balance test (54.2%, p = 0.001) and low mean grip strength (but only in men (p = 0.005)). They also showed some difficulties in daily life activities (climbing stairs, walking one block, both p<0.0001). Age ≥60 years (adjusted OR (aOR) = 3.4; CI95% = 1.9-5.9,), being a female (aOR = 2.1; CI95% = 1.1-4.1), having an abdominal obesity (aOR = 2.1; CI95% = 1.2-4.0), a longer duration of HIV infection (aOR = 2.9; CI95% = 1.5-5.7), old Nucleoside reverse transcriptase inhibitors (NRTIs) (i.e., AZT: zidovudine, ddI: didanosine, DDC: zalcitabine, D4T: stavudine) in current ART (aOR = 2.0 CI95% = 1.1-3.7) were associated with low SPPB performance. As in western countries, physical function limitation is now part of the burden of HIV disease complications of older PLHIV living in West Africa, putting this population at risk for disability. How to screen those impairments and integrate their management in the standards of care should be investigated, and specific research on developing adapted daily physical activity program might be conducted.
Highlights
According to UNAIDS, 6.7 million people aged 50 and older were living with HIV worldwide in 2017, a phenomenon that increased steadily since 1995 [1]
In Cote d’Ivoire, one study reported a higher prevalence of physical function limitation (34%) in middle-aged people living with HIV (PLHIV), with older age and higher Body Mass Index (BMI) being associated with low performance [11]
Longitudinal studies should be performed to assess the evolution of the physical function limitation, their predictors, and to evaluate in more detail their consequences on daily activities
Summary
According to UNAIDS, 6.7 million people aged 50 and older were living with HIV worldwide in 2017, a phenomenon that increased steadily since 1995 [1]. Alteration of physical function (i.e. functional limitation and disability) are more common. A functional limitation is a strong predictor of disability, hospitalization, nursing home admission, and mortality in aging [5,6]. In France, it has been reported that one of two middle-aged PLHIV had poor limb muscle performance [9], that the performance deteriorated over time and that was associated with subsequent falls [10]. In Cote d’Ivoire, one study reported a higher prevalence of physical function limitation (34%) in middle-aged PLHIV, with older age and higher BMI being associated with low performance [11]
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