Cardiometabolic disease among frailty phenotype clusters in adults aging with HIV

BACKGROUND: Age-related morbidity, including frailty and cardiometabolic disease has become increasingly prevalent among people living with HIV (PWH), and each frailty characteristic may, independently and synergistically, play a role in cardiometabolic disease. OBJECTIVE: To evaluate the prevalence of unique frailty clusters and the prevalence ratios of cardiometabolic diseases within frailty clusters among a large diverse cohort of PWH in clinical care. DESIGN: Cross-sectional analyses within longitudinal clinical cohort. SETTING: The Center for AIDS Research Network of Integrated Clinical Systems (CNICS) from 8 Clinics PARTICIPANTS: 4,856 PWH, mean age 61 years. 16 % frail, 45 % pre-frail, 40 % robust. MEASUREMENTS: The validated, modified Fried Phenotype from patient-reported outcomes and clustering (15 clusters) of the frailty characteristics and cardiometabolic diseases (7 diseases and multimorbidity) within each cluster. RESULTS: Among 4856 PWH (age: 61 ± 6 years), the prevalence of frail, pre-frail, and robust was 16 %, 45 %, and 40 %, respectively. The most prevalent cardiometabolic disease among frail PWH was hypertension (62.6 %), followed by dyslipidemia (58.8 %) and diabetes (31.4 %). Among pre-frail PWH, the most prevalent cardiometabolic diseases were dyslipidemia (65.8 %), hypertension (61.8 %), and obesity (30.5 %). The prevalence of cardiometabolic disease among frailty clusters varied. For example, PWH in the "fatigue + poor mobility" cluster had a greater prevalence of cerebrovascular disease (PR: 2.23; 95 % CI: 1.01-4.91), diabetes (1.76; 95 % CI: 1.41-2.21), and obesity (1.66; 95 % CI: 1.35-2.05) when compared with robust PWH. Individuals in the "poor mobility" cluster had a higher prevalence of diabetes (1.37; 95 % CI: 1.15-1.64), hypertension (1.12; 95 % CI: 1.04 - 1.22), and obesity (1.38; 95 % CI: 1.17-1.61) compared with robust PWH. CONCLUSIONS: The frailty components, independently and synergistically, were associated with an increased prevalence of cardiometabolic disease. This study identified distinct frailty clusters that may be associated with increased prevalence of cardiometabolic disease among PWH.