Healthy aging with HIV: My Smart Age with HIV (MySAwH) - Smartphone self-assessment intrinsic capacity in relation to frailty to promote healthy aging in HIV

Background In the context of an emerging aging epidemic affecting people living with HIV (PLWH), so far two conceptual models of aging have been developed - frailty and intrinsic capacity, which was proposed by World Health Organization in 2015. HIV care, that goes beyond the viro-immunological success, may offer an ideal setting to test a possible integration of these models in older adults living with HIV (OALWH). My Smart Age with HIV (MySAwH) is a multi-centre prospective ongoing study with the intention of empowering OALWH to acquire healthy lifestyles and healthy aging. It is based on collection of physical function data and patient-related outcomes through a dedicated smart-phone app (MySAwH App). The aim of MySAwH is to detect health changes assessed with frailty index (FI), collected by health professionals, and with a self-generated intrinsic capacity (IC) index exploring 5 different health domains: locomotion, vitality, sensory, cognition, psychosocial. Objective Our objective was to describe a self-assess measure of IC in relation to frailty status in a prospective multicentre international study of PLWH older than 50 years. We present 9 months follow up interim analyses of PLWH enrolled in a referral clinic in Modena, Hong Kong and Sydney. The secondary objective was to describe FI and IC index changes over time in PLWH from different geographical regions and to assess their ability to predict important geriatric outcomes: quality of life and health score. Methods We included 261 OALWH that were recruited from Italy (128), Australia (100) and Hong Kong (33). Inclusion criteria were: aged > 50 years; undergoing stable ART; routine access to a smartphone. Throughout the study, two scheduled visits were performed, at baseline and follow-up (9 months). Outcome variables were quality of life and health score assessed by EQ5D5L questionnaire; 36-item FI measured which objectively detect the presence of health deficits; 27-item IC index assessed by the patient him/herself. Results Mean age was 56.94 years, 230 (88.12%) patients are men. Median CD4 was 657 c/µL (480-817 IQR) and 252 (98.05%) patients had undetectable HIV viral load. Mean FI at baseline and follow-up were 0.22 (±0.1 SD) and 0.2 (±0.09 SD) respectively, p<0.001. Mean IC at baseline and follow-up were 0.69 (±0.12 SD) and 0.71 (±0.12 SD), p=0.27. Median QoL at baseline and follow-up were 0.88 (0.8-1 IQR) and 0.9 (0.83-1 IQR), p<0.03. Mean HS at baseline and follow-up were 7.6 (±1.68 SD) and 7.63 (±1.56 SD), p<0.001. In a multivariate logistic model, positive predictors for a good health status at follow-up were IC at baseline (OR=6.74, 3.86-11.77) and geographical origin (Hong Kong (OR=1.25, 1.01-1.54)). In the same analysis, using QoL at follow-up as an outcome, positive predictors were IC at baseline (OR=7.62, 4-14.51) and geographical origin (Hong Kong (OR=1.33, 1.05-1.69)). Conclusion This was the first study that aimed to describe both FI and IC in a large cohort of PLWH. There is still no validated tool to assess IC. Our main finding is that baseline IC has a greater ability to predict both QoL and self-perceived health score than FI in PLWH. We have proposed a tool that could contribute to better understand the relationship between frailty index and intrinsic capacity. This study can also be helpful to see how the still theoretical concept of IC can be assessed in real life, and how it changes over time. It remains to be investigated the impact of the environment on health. It also remains to be investigated the role of health coach in the studies like this one, as the presence of this person can be important in promoting healthy lifestyles and positive attitudes despite the presence of co-morbidities. These two issues need to be investigated in further studies.