Physical Function and Frailty in HIV

Abstract

Aging is associated with declines in physical function that can be influenced by many factors, including HIV. These limitations may manifest as increased vulnerability to stressors, or frailty. Functional limitations and frailty can be used to guide clinical decisions, protect people from harm, and avoid strategies that are not likely to provide benefits. Such limitations could also serve as clinically relevant endpoints for some clinical trials. Interventions should ideally focus on early impairments that begin to occur in midlife, well before an individual becomes frail or experiences disabilities. Overall, physical activity is safe and effective in improving physical function, and counseling about physical activity should be a routine component of HIV care to increase the lifespan and healthspan of individuals with HIV. There are some promising pharmaceutical options, but more research is needed to determine the safety and long-term efficacy. This article summarizes an International Antiviral Society-USA (IAS-USA) webinar presented by Kristine M. Erlandson, MD, MS, on July 24, 2020. This webinar is available on demand at https://www.iasusa.org/courses/on-demand-webinar-2020-erlandson/.

Figure 1.

Impairment, limitations, frailty, and disability in an older individual with osteoarthritis. An individual may experience impairment in body function that is identified through history, exam, or imaging. These impairments in function may lead to limitations in activity that could be identified by self-report, or by slowed time on objective assessments such as a Short Physical Performance Battery. Over time, these activity impairments may result in disability if appropriate resources are not available and the individual cannot participant in usual activities. These concepts are related to, but distinct from frailty, which is a vulnerability to stressors and can be characterized through Fried's frailty phenotype or other measures. Adapted from Erlandson et al.

Figure 2.

The cycle of the frailty phenotype. Underlying disease and senescent changes contribute to a loss of muscle mass. This loss of mass may impact strength (grip) and exercise endurance (fatigue), resulting in slower performance (gait). Slower gait and less endurance may contribute to less physical activity (activity). When combined with the loss in muscle mass, energy expenditure decreases, and appetite declines. Decreased caloric consumption may result in weight loss, which contributes to continued loss in muscle mass, perpetuating the cycle. Adapted from Fried et al.