Burden and Determinants of Frailty, Multimorbidity and Decreased Physical Performance in the Barbados HIV-infected Population
With increased access to combination antiretroviral therapy (cART), HIV-infected persons are living longer. Survival gains have been accompanied by a rise in chronic noncommunicable disease (NCD) burden among HIV-infected persons in North America and Europe, and an incipient burden of key geriatric syndromes - frailty, multimorbidity and diminished physical performance – syndromes which lead to increased hospitalization and premature death.
The Caribbean region has the second highest prevalence of HIV worldwide. Though with a lag in the survival gains evidenced in North American and European contexts, given later ART uptake; recent data suggests a rising proportion of older HIV-infected persons in the Caribbean region. Superimposed on the HIV epidemic is a growing chronic NCD epidemic, with the region confronting the highest NCD burden in the Western Hemisphere today. Epidemiologic and pathophysiologic studies suggest that HIV itself may increase the incidence of NCDs and deleterious geriatric syndromes, potentially fueling the devastating collision of the HIV and NCD epidemics in the region.
This proposal seeks to characterize the burden and determinants of frailty, multimorbidity, and diminished physical performance in the context of the colliding Caribbean HIV and NCD epidemics through a prospective study in Barbados, a Caribbean state whose HIV and NCD trends reflect those of the larger region. With Barbados collaborators with significant HIV and NCD expertise, this proposal will lay the foundation for a sustained collaborative research program with a focus on epidemiologic, mechanistic, and intervention studies to promote healthy aging outcomes for HIV-infected persons in the Caribbean region and beyond.
Gregory Kirk, JHSPH.