January 11, 2011

VA Study: Age-Related Declines in Physical Function Slightly More Common in HIV

Editor’s note: In response to concerns about the accuracy of this report, we have edited its contents to better reflect the findings published in AIDS Patient Care and STDs (January 14, 2011). 

Age-related health problems negatively affects physical functioning among HIV-positive people and may exacerbate the effects of aging in this population, according to a new Veterans Administration (VA) study published in the January issue of AIDS Patient Care and STDs. In fact, compared with age-matched HIV-negative veterans, physical function was found to be slightly worse among HIV-positive veterans over the age of 50. 

Researchers have found in recent years that a number of age-related diseases appear to be occurring in HIV-positive people at a younger age than their HIV-negative counterparts. There is disagreement, however, about whether these conditions—including cardiovascular disease (CVD), bone mineral loss, pulmonary diseases and certain cancers—are signs of accelerated aging or other factors associated with HIV infection.

Nevertheless, scientists are eager to better understand the phenomenon of aging-related diseases in HIV and to determine the best ways to care for an aging HIV population. The majority of people with HIV are expected to be older than 50 by the year 2015.

One area of interest is physical functioning. Physical functioning comprises a number of aspects of a person’s physical ability to carry out tasks, ranging from daily chores to strenuous exercise. In HIV-negative people and people with AIDS, defects in physical function have been associated with greater risks of illness and death. Few studies, however, have tried to assess whether reduced physical function is also common—and occurs more frequently—in people with HIV on antiretroviral therapy and relatively healthy immune systems, compared with HIV-negative individuals.

To explore this area, Krisann Oursler, MD, ScM, from the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Healthcare System in Baltimore, and her colleagues from other centers around the United States, compared data on 3,227 HIV-positive and 3,240 HIV-negative military veterans. Most of the study participants were male and nearly half of whom were 50 years of age or older. 

The two groups differed in certain key respects. HIV-positive participants were less likely to report regular exercise, tended to be more underweight, to have a history of injection drug use and to be more likely to have hepatitis C.  The HIV-negative participants were significantly more likely to have cardiovascular disease (CVD) and diabetes.

Across the board, HIV-positive veterans were no more likely to have worse physical functioning than HIV-negative veterans in the study. However, when the researchers adjusted the data for demographics and clinical factors—such as age and the presence of age-related diseases—“physical function was significantly lower in HIV-infected patients compared to uninfected patients, but the effect was very modest.”

In both the 50-to-54 and 55-and-older age groups physical function was worse in the HIV-infected study volunteers, the authors report. "These results," they add, "are supported by [other data involving] exercise performance testing that showed significantly lower aerobic capacity among older HIV-infected patients compared to age-matched uninfected adults."

The study authors noted that HIV-positive veterans in the youngest age group—44 and under—reported higher functioning than uninfected patients. Only this age group of HIV-infected patients had similar frequency of exercise compared to the uninfected patients, suggesting that physical inactivity may be associated with worse physical function among older HIV-infected patients.

In addition to it being nearly twice as common in HIV-negative volunteers, diabetes was much less likely to affect functioning in people living with HIV. According to the authors, “This differential effect of diabetes on function by HIV status was statistically significant, and reflected the finding that a 50-year-old diabetic HIV-infected subject had the equivalent level of function as a 36-year-old diabetic uninfected subject." 

CVD,  which was also more common among HIV-negative veterans, was no more likely associated with reduced physical function among HIV-positive study volunteers. Still, the authors note, “Given that HIV-infected patients may have increased risk of coronary heart disease and cardiac dysfunction, CVD will likely become a significant source of physical disability in HIV-infected patients who are otherwise stable on cART, and thus provides additional incentive to reduce cardiac risk factors.”

The one disease wherein people with HIV were more likely to have reduced physical function compared with HIV-negative participants was chronic lung disease, which was equally common among both groups of patients. HIV-positive sufferers of this condition, which includes emphysema, were more likely to have reduced physical function than HIV-negative sufferers: "[A] a 50-year old HIV-infected subject had the equivalent level of function as a 68.1-year old uninfected subject."

The authors note that they did not have the ability to explore levels of physical functioning as they related to the severity of specific diseases—such as CVD or diabetes—over time. They also state that further research will be needed to confirm their findings.

Nevertheless, Oursler and her colleagues suggests that these findings demonstrate that age-related health issues should be considered important risks factor for poor physical function in this clinical setting. “The study supports further integration of primary health care and prevention into HIV care with increased focus on age-associated comorbidity,” they conclude.

Search: Physical function, aging, age, older, cardiovascular disease, pulmonary, lung, diabetes, Krisann Oursler

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Previous Comments:

poz83diag92alive2011, Boston, 2011-01-17 16:10:48
I exercise hour 3 X week. Need 2 tabs Provigil b4 elliptical- spinal osteopenia,shattered discs, diabetes, ADHD(recent), absurd weight gain. HIV docs study this an KNOW that Tolomere length reflects cell age, tolomeres shorter on HIV cells-T cells being replenished destroyed constantly has to cause aging! Older meds associ. w/mitochondrial toxicity-RBC MCV and MCH enlarged values, bone marrow toxicity-had ITP w/undet VL-500 Tcells. This study is politically motivated? Support SSDI revised GL? UG

poz83diag92alive2011, Boston, 2011-01-17 14:30:02
I posted two comments here that now escape me and received no email about why my feedback was canned by moderator. I am poz since 1983 and find this study laughable. Are they serious that side effects of diabetes at age 49, libidodystrophy again at 49 (not even age causes), high cholesterol, chronic fatigue, diarreah, constant nausea etc. osteopoenia (caused by meds) do not have the effect of aging one at least 2 years for one. I mean my dad is 74 and has less geriatric stuff-study sets up SSDI.

Mark S. King, Ft. Lauderdale, 2011-01-14 11:48:45
The trendy topic of "Aging and HIV" is quickly losing steam, it appears. I've attended all sorts of presentations and read the data, and there's just no compelling evidence that those of us with HIV are headed for more significant problems than anyone else. I'm glad we're being studied like crazy. But the alarmist headlines of the last two years about aging have been a little over the top, and haven't served us well. Thanks for featuring this study. Mark S. King MyFabulousDisease.com

Richard Jefferys, New York, 2011-01-14 09:54:37
I'm concerned that this is not an entirely accurate description of the study results. The paper seems not to say that there was no difference, but rather that the difference was small in these cohorts, with the exception of in people with pulmonary disease. I'd encourage you to consider altering the headline for two reasons 1) There was a small but significant difference in the multivariate analysis 2) It's potentially misleading to say "in HIV" rather than in these specific VA cohorts

Edward, Atlanta, 2011-01-13 15:14:59
Seriously, some of these "studies" smack of pre-conceived outcomes dictated by insurance companies or some other entity. Yeah, maybe that sounds conspiratorial, but sometimes crazy conspiracy theories ARE true. I know from my own personal experiences that the medical issues I'm facing with my body are far accelerated beyond what my physical years would suggest. I am 50 with the body of a 65 year old, and my doctor has said the same thing.

Rebel, NC, 2011-01-13 13:50:58
I don't believe the results, I know that my physiological health is at least a decade ahead of where I WOULD BE if I were negative. I KNOW IT ACCELERATES aging, I am living proof. Maybe they just needed a paycheck to prevent themselves from losing their homes and this "study" enabled them to GET PAID!

William, Salt Lake City, 2011-01-13 11:57:13
I haven't read the orignial study so my comments are related to this report. Wereas the conclusions may be true for some it is not true for me. HIV infection for me has been a daily torture and my litany of physical and mental complications are encyclopedic. This was true before HAART and is true after HAART.

Jeffinprov, , 2011-01-12 15:13:29
I'm a little dubious about the findings of this study, particularly in that the participants were predominantly of military background. I hope and expect that there will be further, mor broadly representative investigation on this issue.

Greg H., Davenport, FL, 2011-01-12 12:50:18
This study doesn’t seem to take into account how the HIV medications, especially the older ones, and taken over a long period of time can produce such things as CVD and diabetes, as well as obesity and other fat distribution problems. I may be delusional, but I honestly believe that if I was HIV-, I would not be dealing with many of the health issues I now have at 58. I also believe that I would be able to function at a much higher level, both cognitively and physically.