Influence of antiretroviral therapy on frailty among people living with HIV

Abstract

The aim of this study is to determine the influence of ARV on the diagnosis of frailty in PLWH. A single-centre prospective observational study was conducted involving PLWH over 18 years old who attended a hospital pharmacy outpatient service between January 2010 and December 2021. Participants were assessed for frailty using the Fried Frailty Phenotype scale and for geriatric syndromes including falls, cognitive impairment, depression, polypharmacy, and risk of malnutrition. ARV regimens were categorized by drug classes and the number of drugs. Associations between ARV and frailty were evaluated using multivariate logistic regression model. 729 PLWH were included, median age of 52 years. Frailty was observed in 15.6% of the participants, with an additional 48.4% classified as pre-frail. Comorbidities were present in 51.7%, with cardiovascular diseases being the most common. Geriatric syndromes were prevalent in 17.1% of the participants, with polypharmacy noted in 15.2%. the study concludes that while specific ARV regimens do not directly influence frailty development in PLWH, prolonged ARV exposure and polypharmacy significantly increase frailty risk. These findings highlight the need for comprehensive management strategies that optimize ARV regimens and minimize polypharmacy to improve the prognosis and quality of life for aging PLWH.

Keywords: Aging; Antiretroviral therapy, highly active; Frailty; Geriatric assessment; HIV infection; Polypharmacy.

Fig. 1

Receiver operating characteristic curve for frailty logistic regression.

Fig. 2

Receiver operating characteristic curve for geriatric syndrome logistic regression.