Frailty prevalence and predictors in older adults with HIV

  • Thomas Levett

Student thesis: Doctoral Thesis


Background: Advances in HIV management have resulted in life expectancy
gains and consequent ageing in people living with HIV (PLWH). Frailty represents
a state of vulnerability to stressor events and is associated with adverse
outcomes. Frailty has been demonstrated in PLWH at earlier ages and in higher
prevalence than HIV-negative cohorts. A comprehensive evaluation of frailty and
frailty correlates is lacking in a UK based HIV cohort.
Aims: To establish frailty prevalence for a cohort of older adults with HIV in
Sussex, and describe associations between frailty and sarcopenia and potential
biological, psychosocial and cognitive predictors.
Methods: 253 participants aged ≥50 (median 59.6) were recruited between
October 2014-October 2015. Frailty was defined by modified Fried frailty
phenotype including five criteria: exhaustion, low activity, weight loss, weak grip
and slow walking speed. Presence of ≥3 denoted frailty, 1-2 pre-frailty and 0
robust. Associations with frailty were evaluated from demographic, clinical,
psychosocial, neurocognitive and functional parameters. A subgroup of 108
underwent DXA scanning to assess for the presence of sarcopenia.
Results: 48/253 met frailty criteria, giving a prevalence of 19% (95% CI 14.6-
24.3). A further 111/253 (43.9%) were prefrail and 94/253 (37.1%) robust. Frailty
was associated with increasing age, number of comorbidities and worsening
mood symptoms, but not HIV factors. Additional correlates with frailty included
financial insecurity, smoking, number of non-antiretroviral medications, chronic
pain, low physical activity, and elevated IL-6. In the DXA subgroup, low muscle
mass was common at 50% with 20% meeting criteria for sarcopenia, which was
associated with increased odds of frailty. Negative psychosocial resources and
poorer cognitive performance were associated with frailty, with positive
psychological traits potentially buffering against higher frailty states.
Conclusion: Frailty is common and occurs prematurely in older adults with HIV.
Frailty was associated with predictors across biological, psychological and social
parameters, suggesting a need to shift emphasis away from a purely biomedical
approach to frailty in PLWH.
Date of AwardMay 2017
Original languageEnglish
Awarding Institution
  • University of Brighton
SupervisorJuliet Wright (Supervisor)

Cite this