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Functional Impairment May Heighten Cardiometabolic Risk Among People Living With HIV


Low functional status based on Duke Activity Status Instrument score was associated with higher cardiometabolic risk among individuals 45 years and older living with HIV, this new multinational cohort study found.

Low self-reported functional status was associated with higher cardiometabolic risk among individuals 45 years and older with HIV, according to data from REPRIEVE, a phase 3 multinational cohort, published in Clinical Infectious Diseases.

While past studies have demonstrated similar findings within a specific country or geographic region, none included a multinational population to compare functional impairment between Global Burden of Disease (GBD) regions or to explore how different factors that contribute to varying impairment may exist among regions.

“Indeed, the factors that may contribute to physical function burdens in higher income countries may be markedly different than those that contribute to functional burden in Sub-Saharan Africa or Asia,” the study authors said. “Furthermore, the HIV epidemics in these regions differ with respect to the proportion of women and the timing and type of antiretroviral therapy (ART) that may influence the development of other comorbidities.”

This study included adults aged 40 to 75 years living with HIV who were receiving ART for at least 6 months; they were randomized to either pitavastatin (Livalo) calcium 4 mg daily or placebo for the study.

A total of 7736 participants were recruited from more than 100 locations in 12 countries. All participants had a CD4 T-cell count above 100 cells/mcL, had no known cardiovascular disease, and had low to moderate traditional risk of atherosclerotic cardiovascular disease (ASCVD).

Fifth-three percent of the participants were from high-income countries, 65% were male, and 48% had received ART for at least 10 years. The Duke Activity Status Instrument (DASI) was used to categorize participants based on impairment level: none, some, moderate, and severe.

Sixty-four percent reported no impairment, 28% some impairment, and 8.2% moderate impairment; 0.31% reported severe impairment. The median (IQR) DASI score was 58.2 (50.2-58.2), the highest score available that reflects the highest functional status, the authors noted.

Adjusted analyses showed significantly more frequent functional impairment among participants from South Asia, with 96% of participants from this area reporting at least some impairment vs participants from high-income regions, Latin America and the Caribbean, Southeast and East Asia, and Sub-Saharan Africa.

While differences were noted between GBD regions, other factors associated with greater functional impairment included:

  • Female sex
  • Black race
  • Older age
  • Current or former smoker
  • Higher body mass index
  • Use of ART for at least 10 years
  • Certain ART regimens

The authors also found greater proportions of higher ASCVD risk scores (> 7.5%) among participants living with HIV reporting at least some functional impairment.

Additionally, moderate to severe impairment was associated with a 45% greater risk of having metabolic syndrome (HR, 1.45; 95% CI, 1.20-1.77) and a 15% greater risk of having the high waist circumference component of metabolic syndrome (HR, 1.15; 95% CI, 1.10-1.19).

“The associations between DASI and cardiometabolic risk suggest that a measure of functional status may improve risk prediction,” the authors explained. “These longitudinal associations will be further investigated over REPRIEVE trial follow-up.”


Erlandson KM, Fitch KV, McCallum SA, et al. Geographical differences in the self-reported functional impairment of people with HIV and associations with cardiometabolic risk. Clin Infect Dis. Published online February 15, 2022. doi:10.1093/cid/ciac098

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