Gait Speed Decline is Associated with Hemoglobin A1C, Neurocognitive Impairment, and Black Race in Persons with HIV.

Abstract

BACKGROUND\nGait speed declines at a faster rate in people with HIV (PWH) than in the general population but the risk factors associated with this decline are not well understood.\n\n\nMETHODS\nIn the AIDS Clinical Trials Group (ACTG) A5322 (HAILO), an observational cohort study of PWH ≥ 40 years of age, those who developed slow gait during the first 3 years of follow-up were compared to persons who maintained normal speed. Associations with demographic and clinical covariates were assessed using multivariable logistic regression.\n\n\nRESULTS\nOf 929 participants, 81% were male, 31% Black, and 20% Hispanic. Median age was 51 years (IQR 46-56). At study entry, 92% had plasma HIV RNA <50 copies/mL with median CD4 count 631 cells/mm3 (IQR 458-840). At study entry, 7% of participants had slow gait, 16% had neurocognitive impairment (NCI), 12% had diabetes. Over 3 years, 87% maintained normal gait speed, 3% maintained a slow gait, 6% developed a slow gait, and 4% improved from slow to normal gait speed. In multivariable models, HbA1C percentage, per one unit increase (OR 1.36; 95% CI=1.03, 1.81; p=0.033), NCI (OR 3.47; 95% CI=1.57, 7.69 p=0.002), and black vs white race (OR 2.45; 95% CI=1.08, 5.59; p=0.032) at entry were significantly associated with development of slow gait compared to those maintaining normal gait speed.\n\n\nSUMMARY\nThe association between baseline hemoglobin A1C and development of slow gait speed highlights an intervenable target to prevent progression of physical function limitations.