Characterization of data-driven geriatric syndrome clusters in older people with HIV: a Mexican multicenter cross-sectional study

Virgilio Hernandez-Ruiz; Neftali Eduardo Antonio-Villa; Brenda E Crabtree-Ramírez; Pablo F Belaunzarán-Zamudio; Yanink Caro-Vega; Fátima Brañas; Hélène Amieva; José Alberto Avila-Funes

doi:10.1016/j.lana.2023.100502

Characterization of data-driven geriatric syndrome clusters in older people with HIV: a Mexican multicenter cross-sectional study

Lancet Reg Health Am. 2023 Apr 29:22:100502. doi: 10.1016/j.lana.2023.100502. eCollection 2023 Jun.

Authors

Virgilio Hernandez-Ruiz¹, Neftali Eduardo Antonio-Villa², Brenda E Crabtree-Ramírez³, Pablo F Belaunzarán-Zamudio³, Yanink Caro-Vega³, Fátima Brañas⁴, Hélène Amieva¹, José Alberto Avila-Funes^{1

5}

Affiliations

¹ INSERM, Bordeaux Population Health Research Center, UMR 1219, University Bordeaux, F-33000, Bordeaux, France.
² Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
³ Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
⁴ Sección de Geriatría, Hospital Universitario Infanta Leonor, Madrid, Spain.
⁵ Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Abstract

Background: As living with HIV has been proposed as a condition that may accelerate aging, the main objective of this work was to estimate the prevalence of geriatric syndromes (GS) among older Mexicans with HIV dwelling in the community. Secondly, to evaluate whether the accumulation of GS could be associated with an adverse HIV-related clinical profile, independent of chronological age.

Methods: Multicenter, cross-sectional study including 501 community-dwelling people aged ≥50 years with HIV. The overall prevalence of nine selected GS and their cumulative number were estimated. An Age-Independent Cumulative Geriatric Syndromes scale (AICGSs) was constructed, and correlations between the AICGSs and HIV-related parameters assessed. Finally, k-mean clustering analyses were performed to test the secondary objective.

Findings: Median age 56 (IQR: 53-61) years, 81.6% of men. Polypharmacy (74.8%), sensorial deficit (71.2%), cognitive impairment (53.6%), physical disability (41.9%), pre-frailty (27.9%), and falls (29.7%), were the more prevalent GS. A significant negative correlation was found between the AICGSs and normalized values of CD4+ nadir cell counts (r = -0.126; 95%: CI: -0.223 to -0.026, p < 0.05). Similarly, a significant inverse adjusted association between the CD4+ nadir cells and the AICGSs was observed on linear regression analysis (β -0.058; 95%: CI: -0.109 to -0.007, p = 0.03). Cluster analysis identified three differentiated groups varying by age, metabolic comorbidities, AICGSs, and HIV-related parameters.

Interpretation: An elevated prevalence of GS was observed in the studied population. Moreover, the accumulation of GS was associated with adverse HIV-related profiles, independent of age. Thus, early detection and management of GS are crucial to promote healthier aging trajectories in people with HIV.

Funding: This work was funded in part by the National Center for the Prevention and Control of HIV/AIDS in Mexico (CENSIDA)-National Ministry of Health.

Keywords: Chronic diseases; Geriatric syndromes; HIV.