HIV and frailty: Just another symptom?

Shaun Watson
Clinical Nurse Specialist (HIV Community)

It seems obvious doesn’t it: we get older we get frailer. But are the two things automatically connected, and what is frailty? To some it’s generalised weakness, the inability to complete activities of living, or is it just an affliction of old age? Within HIV is it just a part of premature ageing associated with the virus, or is it something else? HIV goes through issue and symptom trends such as lipodystrophy, peripheral neuropathy, adherence, osteoporosis, cardiovascular disease, ageing, and frailty appears to be top of the list for 2015. With an older HIV-positive cohort is frailty part of the ageing process or is there more to frailty than just growing old with HIV?
Frailty can be described as a state of physiological exhaustion that increases the morbidity and mortality of HIV-infected patients. This process may be accelerated in HIV-infected patients, even in those taking antiretroviral therapy (ART) [1,2]. HIV is now a (fairly) manageable long-term, chronic illness and AIDS is therefore, in theory, preventable [3]. With the effectiveness of ART we now have an ageing HIV population. In the general population an estimated 50% of individuals over the age of 85 years have some degree of frailty, leading to a high risk for falls, disability, hospitalisation and mortality [4]. Early in the HIV epidemic, frailty was noted to be more common in those with advanced HIV disease, wasting and a low body mass index. However, with the widespread use of ART, recent studies suggest frailty in HIV is now associated with central adiposity (fat), sarcopenia (muscle wastage) and the density of muscle fat [5]. Read more. . .