Photo Credit: Jose carlos Cerdeno

Frailty in HIV was not associated with nadir CD4 count in either univariable or multivariable analysis; rather, it was associated with being single and lonely.

The prevalence of frailty was 16.6% in a cohort of adults with HIV aged 65 years and older, researchers reported in JAIDS.

“Advancements in treatment have resulted in improved survival among people living with HIV. However, additional years of life are not necessarily spent in good health, as frailty tends to develop at a younger age among people living with HIV,” Alice Zhabokritsky, MD, MSc, and colleagues wrote.

The cross-sectional analysis included 439 participants (median age, 69) from the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study. At entry, assessments included the Fried Frailty Phenotype criteria, including unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity. Those meeting three or more criteria are considered frail.

Personal Connections Impact Frailty Risk

The study team determined that 21% of participants met no frailty criteria and were considered robust, 62.4% met between 1 and 2 criteria and were considered prefrail, and 16.6% were considered frail.

When the researchers investigated correlates, frailty was not associated with nadir CD4 count in either univariable or multivariable analysis. Rather, frailty was associated with being single and lonely. After adjusting for nadir CD4 count, age, gender, time since HIV diagnosis, and number of comorbidities, not being in a relationship had an adjusted risk ratio of 2.09, and each 10-point increase on the UCLA Loneliness Scale had an adjusted risk ratio of 1.25.

Targeting Loneliness to Reduce Frailty

The findings “highlight multiple potential ways social connections may be protective for persons aging with HIV (ie, companionship, physical support, financial resources, [and] nutrition),” according to Dr. Zhabokritsky and colleagues.

“Sadly, many long-term HIV survivors, especially older [MSM], have lost partners during the early days of the HIV epidemic, which has had a long-lasting impact throughout their life course.”

In contrast with previous studies, the CHANGE HIV analysis found neither multimorbidity nor severe multimorbidity to be associated with frailty.

“Interventions aimed at reducing loneliness should be assessed in people living with HIV to determine whether this could prevent or reverse frailty and ultimately improve functional status and quality of life,” the researchers wrote. “In the interim, [loneliness and not being in a relationship] should be recognized by clinicians as potential indicators of frailty risk.”