Frailty in HIV: Epidemiology, Biology, Measurement, Interventions, and Research Needs

Abstract

Frailty is a critical aging-related syndrome marked by diminished physiologic reserve and heightened vulnerability to stressors, predisposing to major adverse clinical outcomes, including hospitalization, institutionalization, disability, and death in the general population of older adults. As the proportion of older adults living with HIV increases in the era of antiretroviral therapy, frailty is increasingly recognized to be of significant clinical and public health relevance to the HIV-infected population. This article reviews current knowledge on the epidemiology and biology of frailty and its potential role as a target for reducing disparities in outcomes in HIV; conceptual frameworks and current approaches to frailty measurement; existing data on frailty interventions; and important areas for future research focus necessary to develop and advance effective strategies to prevent or ameliorate frailty and its marked adverse consequences among people living with HIV.

Keywords: Clinical outcomes; Deficit accumulation index; Disparities; Immunosenescence; Physical activity; Physical frailty phenotype.

Fig. 1

Potential integrative context around which to consider frailty in HIV-infected adults, adapted from Walston et al. [79]. The proposed pathways are based on existing evidence derived from the general population, HIV-specific frailty literature, and emerging evidence and multidisciplinary ideas about psychosocial and physiological inter-relationships among contributors, confounders, pathogenesis, phenotypes, and recognized outcomes or behaviors in frailty. HAND, HIV-associated neurocognitive disorder. MCI, mild cognitive impairment. IL-6, interleukin-6. TNFα, tumor necrosis factor alpha. CRP, C-reactive protein. CXCL10, C-X-C motif chemokine 10 or interferon gamma-induced protein. IGF-1, insulin-like growth factor-1, DHEA-S, dehydroepiandrosterone sulfate