The role of oxidative stress indicators in predicting frailty in HIV-infected individuals

With the widespread use of effective antiretroviral therapy (ART) in individuals infected with the human immunodeficiency virus (HIV), viral suppression is achieved. Despite viral suppression, individuals living with HIV are faced with comorbid conditions more frequently and age earlier, due to the ongoing immune activation, oxidative stress and drug side effects. Frailty is a geriatric syndrome that causes an increased risk in terms of poor clinical outcomes including increased sensitivity to various stressors and falls, long-term care need and mortality. Frailty has begun to be investigated too, to identify those who are more vulnerable to death and to measure the effects of disease on well-being, as well as outcomes of treatment among individuals living with HIV. In our study; the relationship between comorbidities increasing in frequency in HIV-infected patients, such as the frailty and associated sarcopenia status, risk of cardiovascular disease and neurocognitive impairment and mortality is investigated. The hypothesis that oxidative damage markers can be used in patients to predict the risk of frailty, sarcopenia, increased mortality risk, neurocognitive impairment, and increased cardiovascular disease is established. For this purpose, malondialdehyde (MDA) and total antioxidant capacity (TAC) levels were examined in patients. Among 71 patients included in the study, 3 patients were found to be frail and 32 patients to be pre-frail. While MDA levels were found to be significantly lower in non-frail patients (p <0.001), decreased muscle strength, low mini mental test (MMT) score and high VACS (Veterans Aging Cohort Study) score were found to be associated with MDA level and frailty (p-values of the relationship between decreased muscle strength, VACS, MMT with MDA respectively: 0.029, 0.031, 0.004). Any relationship between TAC level and frailty was not found. C-Reactive Protein (CRP) and D-Dimer levels, which are among inflammatory markers, were also investigated; and no significant relationship between these markers and oxidative system markers and frailty. As a result of the study, it was found that MDA can be used to predict frailty in individuals living with HIV, and further studies with additional markers of oxidative stress will be of value in a wider patient population.