Frailty Is Associated With Lower Urinary Tract Symptoms in Adults With and Without HIV

Frailty is a risk factor for lower urinary tract symptoms (LUTS) in older adults. People with HIV (PWH) have a heightened frailty burden, but the association of HIV and frailty with LUTS in people with and at risk for HIV is unknown.

Data from 1356 PWH (505 men, 851 women) and 820 without HIV (419 men, 401 women) enrolled in the MACS-WIHS Combined Cohort Study who completed the Lower Urinary Tract Dysfunction Research Network 10-Item Symptom Index (LURN SI-10) from 10/2021 to 9/2022 were included. Frailty was determined using the Fried frailty phenotype (robust, pre-frail, and frail). Regression models stratified by sex evaluated the cross-sectional associations of HIV and frailty with LUTS severity, urgency urinary incontinence (UUI), and overactive bladder (OAB). Due to low prevalence in men, mixed urinary incontinence (MUI) was analyzed only in women. Effect modification by sex and HIV was tested using the interaction terms with frailty.

Mean age was 56 years (SD 11), and 58% of participants were Black. For women, 53% were pre-frail and 23% were frail. For men, 46% were pre-frail and 13% were frail. There was no association of HIV with LUTS. Among women, 21% reported UUI, 61% reported OAB, and 14% reported MUI at least weekly. Compared to robust women, frail women had higher LURN SI-10 scores (absolute difference = 3.3 (95% CI: 2.3, 4.3)). Similarly, frail men had higher LURN SI-10 scores than robust men (absolute difference = 1.6 (95% CI: 0.4, 2.9)). Frailty was associated with greater odds of UUI and OAB in women and men, and MUI in women. There was no evidence of effect modification by sex.

LUTS are common in people with and at-risk for HIV and are more severe among those who are frail. More research is needed to investigate the sex-independent mechanisms that underlie frailty and LUTS in this population.