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Functional Impairment in People Living With HIV: A Global Study

In a global cohort, more than 1 in 3 people living with HIV reported functional impairments. Functional impairment was more common among HIV-positive people who were older, Black, or female.

People living with HIV frequently experience impairments to physical function earlier in life. However, one study featured during the 2022 Annual Conference on Retroviruses and Opportunistic Infection (CROI) explored whether functional status in people living with HIV differs across global regions.

The study, “Geographical Differences in Functional Impairment of People With HIV,” was presented this morning by lead author Kristine Erlandson, an associate professor of medicine and infectious disease at the University of Colorado. Erlandson discussed the REPRIEVE trial, a prospective, double-blind, randomized, placebo-controlled, multicenter, phase 3 study.

Erlandson told Contagion that in a smaller subset of the REPRIEVE study, nearly 40% of participants had impairments to physical function. However, these results were only representative of the US region. Erlandson said, “We were particularly interested in how some of these functional impairments might differ across global burden of disease (GBD) regions, and how a self-reported measure of physical function would perform.”

REPRIEVE examined the efficacy of pitavastatin calcium versus placebo in preventing cardiovascular complications among people living with HIV. The study included participants were people 45-75 years old and on antiretroviral therapy. The cohort represented Global Burden of Disease (GBD) regions, as defined by the World Health Organization (WHO).

The investigators administered the Duke Activity Status Instrument (DASI) to the participants to assess functional capacity by metabolic equivalents. Mobility of the cohort was classified as no, some, moderate, or severe impairment. They looked for any linkage between functional impairment and cardiometabolic risk. The investigators used linear regression models to examine risk factors and the GBD regions correlated with higher rates of physical impairment.

Of the 7736 included participants, 4065 were from high-income countries. CD4+ counts were ≥500 cells/uL for 68% of participants, 48% had been on antiretroviral therapy (ART) for 10 or more years, and 35% were female. Among all participants, 35% reported some impairment.

Erlandson said, “We found over 1/3 of participants with low to moderate cardiovascular disease risk reported function impairments.Similar to what we’ve seen in other study populations, black race, being older or female, and having a longer ART duration were associated with functional impairment.”

Other factors indicated for greater physical impairment included current or former smoking and higher body mass index. The investigators concluded that the correlation between cardiometabolic risk and DASI indicate a measure of functional status could improve prediction of risk.

Erlandson told Contagion that what most surprised her about the results was “the marked differences in function between Southeast/East and South Asia.” Erlandson continued, “We are unsure if these differences are related to cultural differences in question response/interpretation, or true differences in physical function. We were also impressed at the association between physical function and cardiometabolic risk.”

As for next steps for the research, Erlandson said, “We plan to examine how baseline functional impairment predicts cardiometabolic events over the duration of REPRIEVE, and whether including a measure such as physical function can improve cardiometabolic risk prediction in people with HIV.We will also examine changes in functional impairments overtime, both by the self-report using the DASI, and using objective markers of physical function in the substudy.”

The study, “Geographical Differences in Functional Impairment of People With HIV,” was presented virtually during the 2022 Annual Conference on Retroviruses and Opportunistic Infection (CROI).