REPRIEVE試験補助研究のヒト免疫不全ウイルスを持つ中高年の身体機能障害と脆弱性 PREPARE

Physical Function Impairment and Frailty in Middle-Aged People Living With Human Immunodeficiency Virus in the REPRIEVE Trial Ancillary Study PREPARE.

• Triin Umbleja
• Todd T Brown
• Edgar T Overton
• Heather J Ribaudo
• Jennifer A Schrack
• Kathleen V Fitch
• Pamela S Douglas
• Steven K Grinspoon
• Sarah Henn
• Roberto C Arduino
• Benigno Rodriguez
• Constance A Benson
• Kristine M Erlandson

抄録

背景:

ヒト免疫不全ウイルス（PWH）感染者は、身体機能障害と虚弱性の発症が加速するリスクがあり、どちらも転倒、入院、死亡のリスクの増加に関連しています。身体機能障害と虚弱性に関連する因子を特定することは、目標とする介入の助けになる。

BACKGROUND: People with human immunodeficiency virus (PWH) are at risk for accelerated development of physical function impairment and frailty; both associated with increased risk of falls, hospitalizations, and death. Identifying factors associated with physical function impairment and frailty can help target interventions.

方法:

REPRIEVE試験では、CD4+ T細胞数が100 cells/mm3を超え、安定した抗レトロウイルス療法を受けている40～75歳の参加者が登録され、心血管疾患のリスクが低いか中等度であることが確認された。登録時に補助試験であるPREPAREに同時登録されている方を対象に横断的解析を行った。

METHODS: The REPRIEVE trial enrolled participants 40-75 years of age, receiving stable antiretroviral therapy with CD4+ T-cell count >100 cells/mm3, and with low to moderate cardiovascular disease risk. We conducted a cross-sectional analysis of those concurrently enrolled in the ancillary study PREPARE at enrollment.

結果:

266人の参加者のうち、年齢中央値は51歳、男性81％、黒人45％、高血圧症28％であった。体格指数（BMI：体重をキログラムで割ったもの、身長をメートル二乗で算出）は、38％で25～30未満、30％で30以上であり、33％が腰囲が高い、89％が運動不足、37％（95％信頼区間、31％、43％）が身体機能障害（Short Physical Performance Battery score≤10）、6％（4％、9％）が虚弱者、42％が前かがみであった。調整後の解析では、高齢、黒人人種、BMIの増加、身体活動の低下は身体機能障害と関連しており、うつ病や高血圧は虚弱体質や偏屈体質と関連していた。

RESULTS: Among the 266 participants, the median age was 51 years; 81% were male, and 45% were black, and 28% had hypertension. Body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was 25 to <30 in 38% and ≥30 in 30%, 33% had a high waist circumference, 89% were physically inactive, 37% (95% confidence interval, 31%, 43%) had physical function impairment (Short Physical Performance Battery score ≤10), and 6% (4%, 9%) were frail and 42% prefrail. In the adjusted analyses, older age, black race, greater BMI, and physical inactivity were associated with physical function impairment; depression and hypertension were associated with frailty or prefrailty.

結論:

身体機能障害は中年のPWHによく見られた；BMIの増加と身体活動の低下は、加齢に伴う身体機能のさらなる低下を防ぐために重要な修飾因子であると考えられる。

CONCLUSIONS: Physical function impairment was common among middle-aged PWH; greater BMI and physical inactivity are important modifiable factors that may prevent further decline in physical function with aging.

臨床試験登録:

NCT02344290。

CLINICAL TRIALS REGISTRATION: NCT02344290.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.