Frailty Transition Among Older Adults Living With HIV in Thailand: A 5-Year Longitudinal Study

Frailty is highly prevalent among older people with HIV (PWH), driven by multimorbidity and HIV-associated accelerated ageing. We investigated frailty transitions and associated factors over a 5-year follow-up period in an ageing cohort of PWH in Thailand.

We conducted a prospective cohort study among PWH aged ≥50 years in Bangkok, Thailand, between May 2015 and June 2024. Frailty phenotypes were assessed at baseline and at 5 years of follow-up using the Fried frailty phenotype, including unintentional weight loss, low physical activity, exhaustion, weak grip strength and slow walking speed. Multinomial logistic regression was performed to identify factors associated with frailty progression and reversibility over follow-up.

Among 324 participants enrolled (63% male; median age of 54 [IQR, 52-59] years), 158 (49%) were robust, 153 (47%) were pre-frailty and 13 (4%) were frailty at baseline. Over 5 years, 111 participants (34%) experienced frailty worsening, 158 (49%) remained stable and 55 (17%) demonstrated frailty reversal. Among 158 PWH who were robust at baseline, 75 (47%) remained robust, 57 (36%) transitioned to pre-frailty and 26 (16%) progressed to frailty. Notably, among those frail at baseline (N = 13), 65% improved to pre-frailty or robustness. Low physical activity was the most common frailty component at baseline, while weak grip strength was the most predominant frailty phenotype at year 5. In multivariable analysis, multimorbidity (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI]: 1.42-6.72, p = 0.004), antiretroviral therapy (ART) duration>20 years (aOR 1.82, 95% CI: 1.08-3.06, p = 0.025) and baseline vitamin D deficiency (aOR 1.85, 95% CI: 1.10-3.10, p = 0.019) were independently associated with increased frailty over the 5-year follow-up. Conversely, multimorbidity (aOR 0.44, 95% CI: 0.44 [0.23-0.84], p = 0.013) and CD4 counts< 500 cells/mm³ (aOR 0.25, 95% CI: 0.10-0.62, p = 0.003) were associated with a lower likelihood of frailty reversal.

Frailty among PWH aged ≥50 years in Thailand was common and highly dynamic, with over half of frail participants improving over 5 years. Multimorbidity, prolonged ART exposure and vitamin D deficiency were key predictors of frailty progression, whereas CD4< 500 cells/mm³ and multimorbidity reduced the likelihood of frailty reversal. These findings highlight frailty as modifiable and support integrating routine frailty screening and geriatric-informed care into long-term HIV services.

NCT00411983.