HIV and musculoskeletal frailty: implications for care, policy and research

指导我们研究的广泛目标是为临床医生和决策者提供重要的见解 关于干预措施在诊断、预防和减少老年人身体虚弱(PF)进展方面的价值 艾滋病毒携带者(PWH)。 美国有100多万人携带艾滋病毒，这是一种以前致命的感染，现在已经成为一种 使用抗逆转录病毒疗法高度可治疗的慢性疾病。威尔斯亲王医院现在的预期寿命 接近于普通人群，显示PF的患病率比预期更早，并在不断增长。酚醛树脂 给个人和社会带来沉重的负担。如果不加以管理，它可能会导致失去独立性，反复发作 跌倒、骨折、残疾和死亡。PF的常规筛查和管理并不是 治疗指南，转而侧重于艾滋病毒流行早期的机会性感染，以及更多 近期对丙型肝炎合并感染、心血管疾病、烟草等物质使用障碍进行了研究。 在诊断和处理PF及其相关疾病方面的挑战进一步加剧了PWH “我们所知道的”和“我们所做的”之间的差距。有证据表明，PF的前期和早期 及时的诊断和有效的干预措施是可逆的。然而，这一证据还没有被翻译成 到常规的艾滋病护理。定期的易损性评估对于防止跌倒、骨折和其他后果至关重要， 然而，大多数威尔斯亲王医院还没有被评估为PF。证据还表明，多式联运干预包括 心血管和力量锻炼与预防跌倒、治疗骨质疏松症相结合，并仔细 药物降级治疗能有效减少PF的肌肉骨骼表现。有类似的 对威尔斯亲王医院的好处，然而，这一证据并没有转化为常规的艾滋病毒护理。选择指南 在有效的干预措施中，缺乏在预算有限的情况下最大限度地提高威斯康星医院的健康效益。 了解这些方案的成本效益(价值)和预算影响将有助于促进 将研究成果转化为重症肝炎的临床治疗。 成本-效果分析是一种重要的方法，有助于在多种有效药物中进行选择 当包括数据、时间和金钱在内的资源有限时，计划。我们打算开发一台计算机 模拟模型描绘了PWH中PF的自然历史和治疗，以缩小两者之间的差距 通过评估预防和减缓疾病进展的三大战略的价值来获得证据和实践 PWH中的PF：1)及时诊断PF；2)实施结构化强化和心血管 健身锻炼计划，以减少跌倒和骨折，预防PF的发生和减缓其 进展；以及3)使用预防跌倒的计划，包括综合药房降级、骨质疏松 筛查、诊断和治疗，以减少跌倒和骨折。

The broad objective guiding our research is to provide critical insights to clinicians and decision makers regarding the value of interventions to diagnose, prevent and reduce progression of physical frailty (PF) in people with HIV (PWH). More than a million persons in the United States live with HIV, a previously fatal infection that has become a highly treatable chronic condition with the use of antiretroviral therapy. The life expectancy of PWH now approaches that of the general population, revealing an earlier than expected and growing prevalence of PF. PF carries substantial individual and societal burden. If unmanaged, it may lead to loss of independence, recurrent falls, fractures, disability, and death. Routine screening and management of PF has not been part of the treatment guidelines, which instead focused on opportunistic infections early in the HIV epidemic, and more recently on HCV co-infection, CVD, and tobacco and other substance use disorder. The challenges in diagnosing and managing PF and its associated conditions in PWH are further exacerbated by the gap between ‘what we know’ and ‘what we do.’ Evidence indicates that pre-frailty and early stages of PF are reversible with timely diagnosis and effective interventions. However, this evidence has not been translated to routine HIV care. Regular frailty assessment is essential to prevent falls, fractures and other consequences, yet most PWH have not been assessed for PF. Evidence also suggests that multimodal interventions including cardiovascular and strength exercise in conjunction with fall prevention, treatment of osteoporosis, and careful medication de-escalation are effective in reducing musculoskeletal manifestations of PF. There are similar benefits for PWH, however this evidence has not been translated into routine HIV care. Guidance on choosing among effective interventions to maximize health benefits for PWH with constrained budgets is lacking. Knowledge of the cost-effectiveness (value) and budgetary impact of these programs would help facilitate translation of research findings into clinical management of PWH. Cost-effectiveness analysis is an important methodology that helps to inform choice among multiple efficacious programs when resources including data, time, and money are limited. We propose to develop a computer simulation model that portrays the natural history and treatment of PF in PWH to narrow the gap between evidence and practice by assessing the value of three major strategies to prevent and attenuate progression of PF in PWH: 1) timely diagnosis of PF; 2) implementation of structured strengthening and cardiovascular fitness improvement exercise programs to reduce falls and fractures and prevent PF incidence and slow its progression; and 3) use of fall prevention programs, including polypharmacy de-escalation, osteoporosis screening and diagnosis and management to reduce falls and fractures.