Application of selected muscle strength and body mass cut points for the diagnosis of sarcopenia in men and women with or at risk for HIV infection

Authors: ERLANDSON, KRISTINE - University Of Colorado; TRAVISON, THOMAS - Harvard University; ZHU, HAO - Hebrew Senior Life; MAGAZINER, JAY - University Of Maryland; CORREA-DE-ARAUJO, ROSALY - National Institute On Aging (NIA, NIH); CAWTHON, PEGGY - California Pacific Medical Center Research Institute; BHASIN, SHALENDER - Brigham & Women'S Hospital; MANINI, TODD - University Of Florida; FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; PALELLA, FRANK - Northwestern University; KINGSLEY, LAWRENCE - University Of Pittsburgh; LAKE, JORDAN - University Of Texas; SHARMA, ANJALI - Albert Einstein College Of Medicine; TIEN, PHYLLIS - University Of California; WEBER, KATHLEEN - Hektoen Institute Of Medicine; YIN, MICHAEL - Columbia University; BROWN, TODD - Johns Hopkins University

Submitted to: Journal of Gerontology Medical Science
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/2/2020
Publication Date: 4/7/2020
Citation: Erlandson, K.M., Travison, T.G., Zhu, H., Magaziner, J., Correa-De-Araujo, R., Cawthon, P.M., Bhasin, S., Manini, T., Fielding, R.A., Palella, F.J., Kingsley, L., Lake, J.E., Sharma, A., Tien, P.C., Weber, K.M., Yin, M.T., Brown, T.T. 2020. Application of selected muscle strength and body mass cut points for the diagnosis of sarcopenia in men and women with or at risk for HIV infection. Journal of Gerontology Medical Science. 75(7):1338-1345. https://doi.org/10.1093/gerona/glaa083.
DOI: https://doi.org/10.1093/gerona/glaa083

Interpretive Summary: Persons with human immunodeficiency virus (HIV) may experience more muscle weakness and reduced physical functioning than uninfected people, ultimately resulting in greater physical disability and frailty. Accurate tools are needed to identify persons at greatest risk of decline. We evaluated the performance of novel muscle weakness measures (absolute grip strength, grip strength/body mass index [BMI], grip strength/ body weight, grip strength/total body fat, grip/arm muscle mass (lean mass)) and association with slow walking speed 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). We assessed the prevalence of sarcopenia among 398 men, about half of whom with HIV, from the Multicenter AIDS Cohort Study and 247 women, where 2 to 1 women were HIV positive, from the Women's Interagency HIV Study. The prevalence of muscle weakness ranged from 16-66% among men and 0-47% among women. None of the weakness measures predicted slow walking speed or falls. The combination of muscle weakness and slow walking speed was also not associated with falls. The clinical utility of new sarcopenia measures for identification of slowness or falls in men and women with or at risk for HIV is limited.

Technical 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.