Prevalence and factors associated with frailty among older adults with and without HIV in Kampala, Uganda

Sub-Saharan Africa has the highest prevalence of older adults with HIV worldwide, a subgroup with an increased risk of incident age-related conditions, such as frailty. We investigated the prevalence and factors linked to frailty among older people (aged ≥ 60 years) with HIV (PWH) and age- and sex-matched people without HIV (PWOH) in Kampala, Uganda.

Frailty was assessed using the frailty phenotype, proposed by Fried and colleagues, based on five criteria: unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. We estimated the prevalence of frailty and pre-frailty and fitted a modified Poisson regression model to identify significantly associated factors.

A total of 749 participants (371 PWH and 378 PWOH), 49.5% women, with a mean age of 67 (standard deviation 6.0) years. PWH had a median time of antiretroviral therapy (ART) use of 17 years (interquartile range 12-19), and 94.6% of PWH had viral suppression (viral load < 50 copies/ml). PWH had a similar prevalence of frailty (15.1% vs. 13.5%, P-value 0.53) and prefrailty (45.2% vs. 43.1%, P-value 0.55) compared to PWOH. Frailty was associated with older age, female sex, having no partner, being underweight, presenting food insecurity, and depressive symptoms.

In our study, older PWH and PWOH had a similar prevalence of frailty and prefrailty. This unexpected result may be attributable to the benefits of ART and may reflect substantial improvements in the clinical management of PWH.