Linear regression models were constructed to estimate the average difference in going for walks time and grip strength between HIV-positive women with varying levels of immune injury and HIV-negative women. women on assessments of slowness, weakness, and frailty phenotype. == Introduction == Combination antiretroviral regimens(CART) have led to sustained survival among individuals infected with human immunodeficiency computer virus (HIV). Some estimates show that among adults with AIDS in the era of cART, half will survive more than 16 years after AIDS diagnosis, in contrast to the estimated 1.2 years for AIDS patients from the no or single drug treatment era.1Individuals who begin therapy before progression to clinical AIDS may survive for even longer periods of time. Given this increased survival time, there is growing interest in evaluating how HIV contamination and its treatment may impact broader steps of health in an aging populace.24 Both HIV and aging are thought to impair cognitive, metabolic, and cardiovascular functioning.2,5Research is accumulating to suggest that deterioration of these physiological systems is caused in part Rebeprazole sodium by systemic immune activation and a chronic inflammatory state, which may persist even when HIV replication is adequately suppressed. In both HIV contamination and aging, systemic immune activation causes impaired regenerative capacity and functioning of T cell populations that may hinder antigen-specific responses but may promote generalized inflammation.610Overproduction of such proinflammatory cytokines as interleukin-6 (IL-6) has been associated with significant physiological effects, such Rebeprazole sodium as protein catabolism, bone mineral loss, reduced muscle mass, atherosclerosis, cognitive deficits, and heightened vulnerability to stress.9,11,12Chronic immune activation and inflammation have been implicated in the initiation of disability and frailty.1315Preclinical disability and frailty are correlated with, but impartial of, comorbidities, functional impairment, and age.1422An analysis in the Multicenter AIDS Cohort Study (MACS) of a self-reported frailty-like phenotype found that HIV-positive men were associated with an earlier occurrence of a frailty-like phenotype compared with HIV-negative men.7We hypothesized that women with profound immunological injury, as measured by CD4+T cell depletion and history of clinical AIDS, would be at greater risk for preclinical disability and frailty than HIV-uninfected women. We assessed physical functioning end points in an ongoing prospective cohort study of HIV-positive and HIV-negative women: the Women’s Interagency HIV Study (WIHS). By nesting this work in an existing cohort study, we capitalized around the availability of extensive clinical, behavioral, and psychosocial data. == Materials and Methods == == Study populace == The WIHS is usually a prospective cohort study designed to Rebeprazole sodium investigate the natural and treated history Rabbit polyclonal to PHACTR4 of HIV in women. Women were recruited at six sites across five U.S. cities: Bronx and Brooklyn, NY, Washington, DC, the San Francisco, CA, Bay Area, Los Angeles, CA, and Chicago, IL. A total of 3766 women were recruited to enroll in 19941995 Rebeprazole sodium and again in 20002001. To be eligible for participation, women had to be at least 13 years old, provide informed consent, have blood drawn for HIV testing, and travel to a clinical research site.23Informed consent was obtained in compliance with guidelines for human subject research as mandated by the U.S. Department of Health and Human Services and participating institutions.24WIHS study participants were scheduled to return every 6 months for follow-up. Visits included a structured interview, a physical examination, and specimen collection. Additional details on WIHS recruitment and characteristics have been described elsewhere.2326 == Definition of frailty == We assessed the prevalence of frailty using the syndromic-based definition proposed by Fried et al. that has been validated in several population-based studies, including the Cardiovascular Health Study (CHS).13,21The frailty phenotype is hypothesized to have its own pathophysiology and etiology that is not fully explained by disease, disability, or advanced age. Frailty consists of five characteristics: impaired mobility (slowness), reduced upper body strength (weakness), self-reported physical exhaustion, unintentional weight loss (sarcopenia), and low physical activity (energy expenditure). Specific steps included (1) a short questionnaire evaluating the ability to perform certain tasks, (2) a physical activity questionnaire (PAQ) capturing intensity and duration of 18 activities that range from work to child care, and (3) two performance-based assessments: the timed-gait.