Frailty: is thy name…..universal? Evolving challenges of managing effectively treated older people living with HIV

The increased survival of treated people living with HIV (PLWH) represents a tremendous accomplishment. However, this has not been accompanied by uniform improvements in quality of life. Many PLWH prematurely develop age-related complications and traditional geriatric syndromes, including frailty. This is a potentially reversible state of vulnerability to adverse outcomes. Its operationalization remains challenging. The most commonly used tools, the frailty phenotype and the frailty index, have their advantages and limitations, but predict similar poor outcomes. Yeoh et al. applied both metrics, and a simpler construct, the Edmonton Frail Scale, to a population of Australian PLWH. Although the prevalence of frailty was generally similar to that in other settings, distinct differences occurred between the tools. This paper adds to the literature on this serious condition in this already vulnerable population. Further research is needed before consensus is reached on how to reliably and simply diagnose frailty in PLWH.