Background: Gait and balance deficits are reported in people with living with HIV (PLHIV) and are associated with reduced quality of life. Current research suggests an increased fall-incidence in this population, with fall rates among middle-aged PLHIV approximating that in seronegative elderly populations. Gait and postural balance rely on a complex interaction of the motor system, sensory control and cognitive function. However, due to disease progression and complications related to chronic inflammation, these systems may be compromised in PLHIV. Consequently, locomotor impairments may result that can contribute to increased fall rates.
Objectives: To critically appraise and synthesise available evidence regarding objective gait and balance impairments in PLHIV, and to emphasise those which could contribute to increased fall risk.
Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search of published observational studies was conducted in March 2016. Methodological quality was assessed using the NIH Quality Assessment tool for Observational Cohort and Cross-Sectional Studies. Narrative synthesis of gait and balance outcomes was performed, and meta-analyses where possible.
Results: Seventeen studies were included, with fair to low methodological quality. All studies used clinical tests for gait-assessment. Gait outcomes assessed were speed, initiation-time and cadence. No studies assessed kinetics or kinematics. Balance was assessed using both instrumented and clinical tests. Outcomes were mainly related to centre of pressure (COP), postural reflex latencies, and timed clinical tests. There is some agreement that PLHIV walk slower and have increased COP excursions and -long loop postural reflex latencies, particularly under challenging conditions.
Conclusions: Locomotor deficits exist in PLHIV, but are currently insufficiently quantified. Results should be interpreted cautiously due to heterogeneity and low methodological quality. Future research involving more methodological uniformity is needed to better understand such deficits and to inform clinical decision making.