Frailty – It’s Complicated

The term “Frailty” is often used to identify older persons with loss of strength, less walking speed, and reduced vigor. This diagnosis is thought to be especially true for older persons living with HIV. However, the simple diagnosis, alone, may be more complicated that it seems. The summarized article attempts to clarify these issues.

The study compared the frequency of frailty among older people living with HIV (200 people) with people without HIV (1000 people), using a study population from France. The two groups were matched on age (55-70 years), sex, and education level. Frailty was measured using an accepted questionnaire and measurement tool that includes unexplained weight loss, low physical activity, loss of energy, slow walking speed, and weakness as measured by grip strength. The median age was 62 years and 85% were men. The presence of 1 or 2 of these markers indicated prefrailty and more than 2 indicated frailty. The frequency of prefrailty and frailty grouped together was about 6% in people living with HIV and about 2% in older persons without HIV.

A more complicated analysis was done that corrects for available social and behavioral factors and information on co-occurring diseases and conditions (i.e., multimorbidity). In this case, the presence of only HIV was no longer associated with prefrailty and frailty. When limiting the analysis to just those with HIV, total frailty was associated with symptoms of depression, kidney disease, and the length of time the HIV infection was present.

The conclusion must be made that frailty is more common in older persons with HIV. However, this is because other factors are associated with both frailty and HIV. The challenge is that a diagnosis of frailty should lead to a search for other factors, many of which can be addressed by more complete medical care.

Source: Lellouche, L., et. al. (2021) Brief report: frailty in aging people living with HIV: a matched control study. JAIDS, vol. 88(3) pp. 305-09. doi: 10.1097/QAI.0000000000002759