Poster Q6 - The association between Cytomegalovirus status and frailty symptoms in adults with positive HIV

Introduction: The project aims to find the correlation between cytomegalovirus (CMV) and frailty in HIV patients. It is hypothesized that HIV patients who are positive for CMV would be at a higher risk of frailty, or conversely, frailty can put HIV patients at a higher risk for being positive for CMV. Prior research has shown that intermediate stages leading up to frailty can be analyzed to identify those at high risk. Due to its low cost and fast performance, the upper extremity frailty assessment method has been utilized in collecting patient data. The subjects were segregated according to the following variables: gender, age (younger than 50, and 50 and over), and frailty status (nonfrail, prefrail and frail). Upon patient data collection, Data analyses showed that there is an association between CMV status and frailty. Nevertheless, we cannot know the direction of whether frailty causes CMV or vice-versa.

Materials and

Methods: PWH adults who have been treated successfully with ART at the time (HIV RNA < 50 copies/ml in plasma) were recruited from Banner-University Medicine North (n=136). Inclusion criteria were: a) being able to give informed consent and comply with study procedures; b) age 40 years or above; c) confirmed HIV case (via laboratory test); d) receiving antiretroviral therapy for at least 6 months, with undetectable HIV levels within 90 days of enrollment; and e) the ability to walk a minimum distance of 9.14 m (30 ft) with or without an assistive device (for the frailty assessment). Exclusion criteria were: a) current history of untreated HIV/AIDS; b) history of solid organ or bone marrow transplant or immunosuppressive therapy; c) currently incarcerated; d) severe motor disorders (Parkinson’s disease, multiple sclerosis, or recent stroke); e) severe upper-extremity disorders (e.g., elbow bilateral fractures or rheumatoid arthritis); f) cognitive impairment identified by a Mini-Mental State Examination (MMSE) score ≤ 23) terminal illness (i.e., progressive disease where death within six months is expected as a consequence); and h) speaking a language other than English or Spanish. Written informed consent was obtained according to the principles expressed in the Declaration of Helsinki. The study was approved by the University of Arizona Institutional Review Board. We implemented the Fried phenotype to categorize participants to frailty categories, and the UEF test to provide a frailty score based on the physical function.

Results, Conclusions, and Discussions: One-hundred-and-thirty-four eligible participants were recruited, including 48 CMV- (age=66.2010.36 years) and 86 CMV+ (age=64.97 +/- 11.66 years). None of the demographic information was significantly different between the CMV- and CMV+ groups (p > 0.26, Table 1). The Fried frailty phenotype was not associated with the CMV status in the recruited sample (p=0.11). UEF score, however, was 65% higher among the CMV+ group compared to CMV- (p=0.02). UEF slowness, flexibility, and weakness sub-scores were also significantly different between the groups.

As hypothesized , we observed a worse UEF score, by 65%, among PWH who were categorized as CMV+, compared to CMV- individuals. Interestingly, the Fried frailty phenotype showed no significant association or even trend of higher frailty occurrence in CMV- compared to CMV+ participants; the percentage of pre-frail and frail individuals within the CMV+ group were 38% and 3% in CMV+ vs. 54% and 6% pre-frail and frail in CMV- (Table 1). Of note, the Fried frailty phenotype is validated for older adults over 65, while the age range for the recruited participants in the current study was 40; among participants, seven (5%) were between 40-50 years, 61 (46%) were between 50-65 years, and 66 (49%) were 65 years of age and above. Accordingly, additional analysis was performed to observe the association between the Fried frailty and CMV status only for PWH of age 65 years and above. Findings for this range groups suggested no higher prevalence of frailty defined by the Fried phenotype among CMV+ compared to CMV- participants (36% and 0% pre-frail and frail in CMV+ vs. 67% and 8% pre-frail and frail in CMV-).

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