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J Acquir Immune Defic Syndr. 2019 Jan 1;80(1):118-125. doi: 10.1097/QAI.0000000000001868.

Association of Fibroblast Growth Factor-23 (FGF-23) With Incident Frailty in HIV-Infected and HIV-Uninfected Individuals.

Author information

1
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
2
Department of Medicine, Kidney Health Research Collaborative, San Francisco VA Medical Center, University of California, San Francisco, San Francisco, CA.
3
Department of Medicine, University of California San Diego.
4
Nephrology Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, CA.
5
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
6
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
7
Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX.
8
Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH.
9
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD.

Abstract

BACKGROUND:

In the Multicenter AIDS Cohort Study, we examined whether fibroblast growth factor-23 (FGF-23), a bone-derived phosphaturic hormone involved in bone metabolism, is associated with incident frailty. Furthermore, we examined whether this association differs by HIV serostatus and race.

METHODS:

Of 715 men assessed for frailty and selected for FGF-23 measurements using stored blood samples (2007-2011), 512 men were nonfrail at/before the baseline visit. Frailty was defined by the presence of ≥3 of the following on 2 consecutive 6-month visits within 1 year: unintentional weight loss ≥10 pounds, weakness, slowness, low energy, and low physical activity. We determined the association of FGF-23 levels with incident frailty using proportional hazards models adjusting for sociodemographics, comorbidities, and kidney function.

RESULTS:

Sixty-five percent were HIV-infected; 29% were black. Median baseline FGF-23 levels were lower in HIV-infected vs. HIV-uninfected men (33.7 vs. 39.9 rU/mL, P = 0.006) but similar by race. During a median follow-up of 6.6 years, 32 men developed frailty; they had higher baseline FGF-23 levels vs. men who remained nonfrail (45 vs. 36 rU/mL, P = 0.02). FGF-23 (per doubling) was associated with a 1.63-fold risk of frailty [95% confidence interval (CI): 1.19 to 2.23]; results did not differ by HIV serostatus. Conversely, FGF-23 was associated with a 2.72-fold risk of frailty among blacks (95% CI: 1.51 to 4.91) but had minimal association among nonblacks (hazard ratio = 1.26, 95% CI: 0.77 to 2.05; p-interaction = 0.024).

CONCLUSIONS:

Among men with or at-risk of HIV infection, higher FGF-23 was associated with greater risk of frailty, particularly in blacks. The mechanisms by which FGF-23 may contribute to frailty warrant further study.

PMID:
30299347
PMCID:
PMC6289864
[Available on 2020-01-01]
DOI:
10.1097/QAI.0000000000001868

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