Photo Credit: Astronomia

Depression and cardiovascular disease are two of several demographic and comorbid characteristics that impact the trajectories of frailty in people with HIV.

Frailty among patients with HIV is associated with sociodemographic, behavioral, and biomedical factors. However, whether these factors contribute to changes in frailty over time is not well understood. Furthermore, limited research has assessed these changes or identified predictors of changes in frailty in people with HIV, according to findings published in AIDS.

Evelyn Iriarte Parra, PhD, MSN, RN, and colleagues conducted a longitudinal observational study to examine this. They aimed to estimate latent frailty trajectories and identify corresponding predictors among patients with HIV.

The study included 975 patients with HIV. Frailty components included weakness, physical activity, weight loss, exhaustion, and slowness.

Depression, Physical Activity Impact Frailty in HIV

At baseline, the mean age of the cohort was 51.5; 81.0% were men, and 48.0% were White. More than half of patients (55.4%) were non-frail, 38.6% were pre-frail, and 6.1% were frail. The most frequent frailty criteria in the cohort was weakness (22.4%). Patients had a mean 6.8 frailty assessments over 9 years of follow-up.

Based on latent class growth models, the researchers identified three frailty trajectories:

• Class 1, worsening frailty (8%);
• Class 2, sustained robustness (83%); and
• Class 3, frailty improvement (9%).

Dr. Iriarte Parra and colleagues identified key demographic and comorbid characteristics associated with fluctuations in frailty trajectories over time, including older age, race, sex at birth, select comorbidities, and modifiable behavioral characteristics.

Depression was associated with a fluctuating state of frailty. The adjusted odds ratio (aOR) for worsening frailty versus sustained robustness for depression was 1.80 (95% CI, 1.10-2.95; P=0.02), and frailty improvement versus sustained robustness was 2.89 (95% CI, 1.82-4.59; P<0.001). Cardiovascular disease was a predictor of worsening frailty versus sustained robustness (aOR, 3.39; 95% CI, 1.59-7.22; P=0.002).

Additionally, an association was noted between low levels of physical activity and fluctuating frailty for worsening frailty versus sustained robustness (aOR, 0.54; 95% CI, 0.33-0.88; P=0.01) and frailty improvement versus sustained robustness (aOR, 0.30; 95% CI, 0.18-0.50; P<0.001).

“[Clinicians] should prioritize physical activity promotion and the management of comorbidities … as part of clinical routine care with tailored approaches to preventing or reversing frailty,” the researchers wrote. “Future research should focus on developing and testing specific interventions that target these modifiable factors to determine the most effective frailty prevention and management strategies in older [people with HIV].”