Research Article: Gender differences for frailty in HIV-infected patients on stable antiretroviral therapy and with an undetectable viral load

Date Published: May 9, 2019

Publisher: Public Library of Science

Author(s): José-Ramón Blanco, Inmaculada Barrio, Enrique Ramalle-Gómara, María Isabel Beltran, Valvanera Ibarra, Luis Metola, Mercedes Sanz, José A. Oteo, Estrella Melús, Lucía Antón, Robert Güerri-Fernández.


Patients with HIV infection suffer from accelerated aging. In this context, frailty could be a relevant problem that aggravates the quality of life (QoL) and morbi-mortality of these patients. Our objective was to determine the prevalence of frailty and pre-frailty in HIV-infected patients in our cohort as well as their risk factors and QoL.

This was a prospective cross-sectional study of HIV-infected people aged ≥18 years on a stable antiretroviral regimen (ART) ≥1 year. Frailty was defined by ≥3 of 5 Fried’s criteria: weight loss, low physical activity, exhaustion, weak grip strength and slow walking time. Variables related to sociodemographics, HIV infection, comorbidities, polypharmacy, and QoL were evaluated. Independent predictors of frailty were evaluated using collinearity in a multivariate logistic regression analyses (backward stepwise elimination).

The 248 people studied has a mean age of 49 years, 63.7% were male, and 81% were Caucasian. The prevalence of pre-frailty and fragility was 39.1% and 4.4%, respectively. The main route of HIV acquisition was heterosexual (47.2%). At the inclusion time 26.6% of the patients had AIDS events, 60.9% were anti-HCV negative, and 91.5% had HIV RNA <50 copies/mL (84.3% for ≥1 year); 10.9% had >2 comorbidities, and 13.3% were receiving >5 non-HIV drugs. Frailty patients had a higher age (p 0.006), more sensitive deficits (visual or auditory) (p 0.002), a greater number of falls during the previous year (p 0.0001), a higher Charlson comorbidity index (p 0.001), and a higher VACS index (p 0.001). All comorbidities, excluding bone and liver, were significantly more frequent in fragile patients. The presence of >2 comorbidities and treatment with >5 drugs not related to HIV they were also more frequent in frail patienst (p 0.0001 and p 0.004, respectively). Independent predictors of pre-frailty/frailty in the multivariable analysis differ in men (VACS index, C-reactive protein [CRP], and falls) and women (CRP, AIDS, and menopause). Patients with pre-frailty/frailty had some indicator of a lower QoL.

Factors associated with pre-frailty/frailty in HIV-infected patients differ by gender, which should be considered when establishing measures for prevention. The role of menopause in the risk of pre-frailty/frailty warrants further investigations.

Partial Text

Effective treatments have transformed HIV infection into a chronic disease [1]. As a result, HIV-infected individuals are living longer. In 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) estimated that approximately 4.2 million people aged 50 years or more worldwide are living with HIV [2]. This success has led to the progressive aging of these patients and, as a consequence, the emergence of multiple age-related diseases.

Frailty assessment was performed in 248 HIV-infected patients. The characteristics of the patients are shown in Table 1. The prevalence of frailty and pre-frailty was 4.4% and 39.1%, respectively. Frailty was associated with a mean older age (59.5 years vs. 47.7 years in robust) (p 0.006), and feeling older than actual age (p 0.03). Groups were comparable in terms of gender, race, education rate, urban place of residence, marital status, tobacco, alcohol and marijuana use. In women, no differences were observed after analysis of previous pregnancy, number of births or menopause.

The present study shows the high prevalence of pre-frailty/frailty (43.5%), and what is especially worrying, 39.8% were younger than 50 years.




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