Inflammation in frailty, cognitive impairment, clinical events and mortality among older adults with HIV in the ACTG HAILO cohort.

Associations between inflammatory markers and prevalent or incident frailty, cognitive impairment, clinical events and mortality in older people with HIV are poorly understood. An observational cohort study. Participants ≥50 years from the ACTG HAILO cohort study were included. Participants completed annual evaluations for cognitive impairment and frailty. Clinical events included non-AIDS-defining cancers, diabetes and cardiovascular, liver and kidney diseases. Associations between inflammatory markers (hsCRP, IL-6, TNFR1, CXCL-9 and inflammatory index score [IIS]) at baseline and prevalence and incidence of frailty, cognitive impairment, any clinical event and non-accidental mortality were examined. We used 10-fold cross validation to examine whether the combination of inflammatory markers and frailty improved the ability to predict incident outcomes. Among 484 participants (17% assigned female at birth, 25% Black and 20% Hispanic), median age was 56 years. Median BMI was 27 kg/m2, median CD4 count was 627 cells/mm3, and 95% had HIV-1 RNA <200 copies/mL. HsCRP, IL-6, TNFR1, CXCL-9 and IIS were associated with increased risk of prevalent frailty and clinical events, but not cognitive impairment. CXCL-9 (Q4 vs. Q1) and TNFR1 were associated with an increased incidence of both frailty and clinical events; Q4 vs Q1 of the IIS was associated with clinical events; increased inflammatory markers (except CXCL-9) were associated with an increased risk of mortality. TNFR1 combined with frailty modestly improved the predictability of incident clinical events and mortality over frailty alone. Several inflammatory markers were associated with increased risk of frailty, clinical events, and mortality, but not cognitive impairment.