Objective: To identify the association between CD4+T lymphocyte (CD4) counts and physical frailty among HIV-infected people aged 65 years and older, and evaluate whether this association will be modified by the indicators of body composition. Methods: From May to October 2022, 485 elderly HIV-infected patients receiving antiretroviral therapy (ART) were recruited from 7 antiviral treatment sites in Jiangjin District Center for Disease Control and Prevention, Chongqing. The data of basic characteristics (age and gender), living habits (smoking and drinking) and disease history (metabolic diseases, cardiovascular and cerebrovascular diseases, respiratory disease and malignant tumors) were collected through the face-to-face investigation with self-made questionnaires. Fried Frailty Scale was used to evaluate the status of physical frailty. Physical fitness (walking speed, grip strength, height, and weight) and body composition (skeletal muscle mass, body fat mass, and basal metabolic rate) were measured. The antiretroviral treatment data were obtained from the China AIDS Integrated Prevention and Treatment Data information management system. The prevalence of physical frailty was calculated among the HIV-infected patients. The potential effects of CD4 counts on physical frailty were explored by using multivariate logistic regression. Subgroup analyses were repeated in the logistic regression with muscle mass, body fat mass, and other indicators of body composition as subgroup variables to determine whether the association might be modified by body composition. Results: The age of 485 patients were (72±5) years old, of which 48.2% (234 cases) were>70 years old and 70.9% (344 cases) were male, and all of whom had initiated the ART treatment. The prevalence of physical frailty among these patients was 7.4% (36/485). Multivariate logistic regression showed that after adjusting for age, sex, smoking, drinking, body composition index, ART duration, viral load and the number of comorbidities, increased CD4 cell level was associated with decreased prevalent risk of physical frailty among elderly HIV-infected patients. For every increase of 5.0×107 CD4 cells/L, the prevalent risk of physical frailty decreased by 12% [OR (95%CI): 0.88 (0.76-1.01)]. Compared with the low CD4 cell level group, the risk of physical frailty in those with normal CD4 cell level decreased by 69% [OR (95%CI): 0.31 (0.10-0.92)]. Subgroup analysis of body composition indicators showed that the protective effect of normal CD4 cell level on physical frailty was more pronounced in the high skeletal muscle mass and high basal metabolic rate group (Pinteraction<0.05). Conclusion: The prevalence of physical frailty among elderly HIV-infected patients is relatively lower in Chongqing, and the CD4 cell level, skeletal muscle mass and basal metabolic rate are related to physical frailty.
目的： 探索CD4+T淋巴细胞（CD4细胞）计数水平与老年HIV感染者生理衰弱患病的关联关系及体成分指标对二者的修饰作用。 方法： 2022年5—10月于重庆市江津区疾病预防控制中心辖区内7家抗病毒治疗点招募485例接受抗反转录病毒治疗（ART）的老年HIV感染者。采用自制问卷通过面对面调查收集对象基本特征（年龄和性别）、生活习惯（吸烟和饮酒情况）和疾病史情况（包括代谢性疾病、心脑血管疾病、呼吸系统疾病和恶性肿瘤）等资料。采用Fried量表评估研究对象的生理衰弱情况。进行体质（步速、握力、身高和体重）和体成分（骨骼肌量、体脂肪量和基础代谢率）测量。由中国艾滋病综合防治数据信息管理系统获取对象抗反转录病毒治疗资料。计算老年感染者生理衰弱现患率，采用多因素logistic回归探索不同CD4水平对老年HIV感染者生理衰弱的影响，并对体成分指标进行亚组分析探索是否存在交互作用。 结果： 485例对象年龄为（72±5）岁，其中>70岁者占48.2%（234例），男性占70.9%（344例），且已全部启动抗病毒治疗。老年HIV感染者生理衰弱率为7.4%（36/485）。多因素logistic回归模型分析显示：调整年龄、性别、吸烟、饮酒、体成分指标、ART时长、病毒载量和合并症数量等因素后，CD4细胞水平增加与老年HIV感染者生理衰弱患病风险下降相关；CD4细胞每增加5.0×107个/L，老年感染者生理衰弱患病风险下降12%［OR（95%CI）：0.88（0.76~1.01）］；与CD4细胞低水平组相比，CD4细胞正常水平组生理衰弱风险下降69%［ OR（95%CI）：0.31（0.10~0.92）］。体成分指标亚组分析显示：CD4细胞水平与生理衰弱的关联在高骨骼肌量和高基础代谢率感染者中更强（P交互值<0.05）。 结论： 重庆市老年HIV感染者生理衰弱率相对较低；CD4细胞水平、骨骼肌量和基础代谢率与生理衰弱有关联。.