Kristine M Erlandson1, Thomas G Travison2,3, Hao Zhu3, Jay Magaziner4, Rosaly Correa-de-Araujo5, Peggy M Cawthon6,7, Shalender Bhasin8, Todd Manini9, Roger A Fielding10, Frank J Palella11, Lawrence Kingsley12, Jordan E Lake13, Anjali Sharma14, Phyllis C Tien15,16, Kathleen M Weber17, Michael T Yin18, Todd T Brown19. 1. Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado. 2. Department of Medicine, Harvard Medical School, Boston, Massachusetts. 3. Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts. 4. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. 5. Division of Geriatrics and Clinical Gerontology, National Institutes of Health, National Institute on Aging, Bethesda, Maryland. 6. California Pacific Medical Research Institute, San Francisco. 7. Department of Epidemiology and Biostatistics, University of California, San Francisco. 8. Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 9. Department of Aging and Geriatric Research, University of Florida, Gainesville. 10. Jean Mayer USDA Human Nutrition Research Center, Tufts University, Boston, Massachusetts. 11. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 12. Graduate School of Public Health, University of Pittsburgh, Pennsylvania. 13. Department of Medicine, University of Texas Health Science Center at Houston. 14. Department of Medicine, Albert Einstein College of Medicine, Bronx, New York. 15. Department of Medicine, University of California San Francisco. 16. Department of Veterans Affairs Medical Center, San Francisco, California. 17. Cook County Health and Hektoen Institute of Medicine, Chicago, Illinois. 18. Department of Medicine, Columbia University Irving Medical Center, New York, New York. 19. Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Abstract
BACKGROUND: Persons with HIV may experience greater mobility limitations than uninfected populations. Accurate tools are needed to identify persons at greatest risk of decline. We evaluated the performance of novel muscle weakness metrics (grip, grip/body mass index [BMI], grip/weight, grip/total body fat, grip/arm lean mass) and association with slowness and falls in older persons with or at risk for HIV infection as part of the work of the Sarcopenia Definitions and Outcomes Consortium (SDOC). METHODS: We assessed the prevalence of sarcopenia among 398 men (200 HIV+, 198 HIV-) from the Multicenter AIDS Cohort Study and 247 women (162 HIV+, 85 HIV-) from the Women's Interagency HIV Study using previously validated muscle weakness metrics discriminative of slowness. Sensitivity and specificity were used to compare new muscle weakness and slowness criteria to previously proposed sarcopenia definitions. RESULTS: The prevalence of muscle weakness ranged from 16% to 66% among men and 0% to 47% among women. Grip/BMI was associated with slowness among men with HIV only. Grip/BMI had low sensitivity (25%-30%) with moderate to high specificity (68%-89%) for discriminating of slowness; all proposed metrics had poor performance in the discrimination of slowness (area under the curve [AUC] < 0.62) or fall status (AUC < 0.56). The combination of muscle weakness and slowness was not significantly associated with falls (p ≥ .36), with a low sensitivity in identifying those sustaining one or more falls (sensitivity ≤ 16%). DISCUSSION: Clinical utility of new sarcopenia metrics for identification of slowness or falls in men and women with or at risk for HIV is limited, given their low sensitivity.
BACKGROUND: Persons with HIV may experience greater mobility limitations than uninfected populations. Accurate tools are needed to identify persons at greatest risk of decline. We evaluated the performance of novel muscle weakness metrics (grip, grip/body mass index [BMI], grip/weight, grip/total body fat, grip/arm lean mass) and association with slowness and falls in older persons with or at risk for HIV infection as part of the work of the Sarcopenia Definitions and Outcomes Consortium (SDOC). METHODS: We assessed the prevalence of sarcopenia among 398 men (200 HIV+, 198 HIV-) from the Multicenter AIDS Cohort Study and 247 women (162 HIV+, 85 HIV-) from the Women's Interagency HIV Study using previously validated muscle weakness metrics discriminative of slowness. Sensitivity and specificity were used to compare new muscle weakness and slowness criteria to previously proposed sarcopenia definitions. RESULTS: The prevalence of muscle weakness ranged from 16% to 66% among men and 0% to 47% among women. Grip/BMI was associated with slowness among men with HIV only. Grip/BMI had low sensitivity (25%-30%) with moderate to high specificity (68%-89%) for discriminating of slowness; all proposed metrics had poor performance in the discrimination of slowness (area under the curve [AUC] < 0.62) or fall status (AUC < 0.56). The combination of muscle weakness and slowness was not significantly associated with falls (p ≥ .36), with a low sensitivity in identifying those sustaining one or more falls (sensitivity ≤ 16%). DISCUSSION: Clinical utility of new sarcopenia metrics for identification of slowness or falls in men and women with or at risk for HIV is limited, given their low sensitivity.
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