May 5, 2017
Grip strength fell faster after age 50 in men with HIV than in a similar group of HIV-negative men, according to a 7-year analysis in the United States.1 A simple measure of physical function, grip strength predicted declining function and death in previous studies. The new study is the first to compare grip strength over several years in older HIV-positive men and in a group of similar men without HIV infection.
Thanks to antiretroviral therapy, people with HIV infection are living much longer. In 2014 about half of all people living with HIV in the United States were 50 or older.2 But many studies show that older people with HIV face a higher risk of serious disease and disability than people the same age without HIV. Muscle strength is an essential part of healthy living at any age. Research shows that grip strength -- easily measured with a simple device -- represents strength in the whole body. Studies indicate that grip strength predicts disability, sickness, and death in middle-aged and older people.
To compare changes in grip strength over the course of several years, U.S. researchers conducted this study in middle-aged and older men with HIV and a similar group of HIV-negative men about the same age.
The study involved HIV-positive and negative gay/bisexual men in the Multicenter AIDS Cohort Study (MACS). The MACS is an ongoing U.S. study in which men make study visits twice a year to get examined and have health-related tests.
Since October 2007 men had a grip strength test twice a year using a simple hand-held squeeze device that measures strength on a meter. Men took the grip strength test from October 2007 or from the date they entered MACS until a final measurement in 2014. The investigators defined weakness as a grip strength less than 26 kilograms.
The researchers used a standard statistical method to determine change in grip strength over time. This kind of analysis accounts for the impact of several factors that may affect grip strength. So individual factors that may influence grip strength -- like HIV infection -- can be said to have that effect regardless of whatever other factors are involved. The research team conducted a separate statistical analysis only in men with HIV to assess the impact of several HIV-related factors on grip strength.
The study focused on 716 HIV-positive men and 836 men without HIV. All were at least 50 years old at their first study visit, and all had two or more study visits between October 2007 and September 2014. Age averaged 53.4 years in men with HIV and 56 years in HIV-negative men. The HIV group included a higher proportion of nonwhites (34.5% versus 20.7%) and a higher proportion who used drugs at some time (50.6% versus 39.8%). Men with HIV had taken an HIV-drug combination for an average 9.1 years, and 78.5% had a viral load below 200 copies.
Average grip strength at age 50 was similar in men with HIV (37.9 kilograms) and men without HIV (38.2 kilograms) (Figure 1). But after age 50 grip strength fell faster in HIV-positive men (0.42 kilogram per year) than in HIV-negative men (0.33 kilogram per year) (Figure 1). This difference is statistically significant -- meaning that a statistical test indicates that chance does not explain the difference. Compared with HIV-negative men, men with HIV had a 70% greater risk of weakness as measured by grip strength. Other factors linked to a significantly faster drop in grip strength were lower body mass index (weight), nonwhite race, less education, kidney disease, and peripheral neuropathy (persistent weakness, numbness, or pain in the feet or hands).
Figure 1. At age 50 men with HIV had an average grip strength (measured in kilograms, kg) similar to men without HIV. But after age 50, men with HIV lost more grip strength yearly than men without HIV. (Credit: Teresa B. Southwell)
The researchers divided men with HIV into three groups according to how often they had an undetectable viral load at a study visit: undetectable at every study visit, detectable at 1 to 6 visits, and detectable at 7 or more visits (Figure 2). In this analysis HIV-negative men lost grip strength at a rate of 0.39 kilogram per year. In contrast, HIV-positive men with an undetectable viral load at every study visit lost grip strength at a rate of 0.48 kilogram per year; HIV-positive men with a detectable viral load at 1 to 6 visits lost grip strength at a rate of 0.79 kilogram per year; and men with a detectable viral load at 7 or more visits lost grip strength at a rate of 2.39 kilograms per year.
Figure 2. Compared with HIV-negative men, HIV-positive men 50 or older lost more grip strength yearly -- and the drops were greater in men with viral load (VL) detectable at more study visits. (Credit: Teresa B. Southwell)
To get an idea of factors that contribute to falling grip strength in men with HIV, the researchers divided those men into two groups -- 106 men who became weak during the study (grip strength below 26 kilograms) and 610 men who did not become weak (grip strength always 26 kilograms or higher). The weak group differed significantly from the nonweak group in four ways:
Years infected with HIV or total time taking antiretroviral therapy did not differ significantly between weak men and nonweak men.
This study focused on grip strength -- an easily measured indicator of overall strength and survival. At age 50 gay/bisexual men with HIV had an average grip strength similar to gay/bisexual men without HIV. But as men grew older than 50, the HIV group lost grip strength faster than the HIV-negative group. And men with HIV ran a higher risk of weakness (as defined by grip strength). Decreased strength could contribute to lower quality of life and shorter survival in people with HIV.
HIV-positive men in this study who kept their viral load undetectable all or most of the time lost grip strength more slowly than men whose viral load was detectable more often. The only way to make your viral load undetectable -- and to keep it undetectable -- is to start antiretroviral therapy and then to take all your HIV medications on time, exactly as your provider instructs. This study adds to the reasons people with HIV should begin antiretroviral therapy as soon as they know they have HIV and then make steady pill-taking a priority of their health care.
The researchers who conducted this study note that further research is needed to develop specific strategies to help preserve strength in aging people with HIV. But it is already clear that a healthy diet and regular physical activity and exercise help people maintain strength as they age. If you do not already exercise, you should get advice from your health care team and other knowledgeable people about planning an exercise program. The types of physical activity or exercise you do should be the types you like and can do regularly. You should talk to your provider before starting any strenuous exercise program. The U.S. Office of Disease Prevention and Health Promotion suggests several types of exercise or physical activity to strengthen muscles or promote heart health in older adults (Table 1).3
|Table 1. Exercises to Strengthen Muscles and Promote Heart Health in Older Adults|
|Muscle-Strengthening Exercises||Heart Health Exercises|
Source: Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Physical activity guidelines. Chapter 5. Older adults.
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