Prevalence, factors and quality of life associated with frailty and pre-frailty in middle-aged and older adults living with HIV in Zimbabwe: a cross-sectional study

Objectives
We investigated associations between HIV, frailty, and health-related quality of life (HRQoL).

Methods
This cross-sectional study recruited men and women aged ≥40 years in Zimbabwe. A researcher collected clinical and HRQoL data, performed physical assessments and HIV testing. Frailty was defined using five criteria: unintentional weight loss, exhaustion, low physical activity, low gait speed, low handgrip strength. Presence of ≥3 criteria defined frailty, 1-2 pre-frailty, and 0 non-frail. Data analysis used adjusted regression modelling.

Results
Of 1034 adults (mean±SD 62.0±14.0 years), 21.6% (n=223) were living with HIV: 93.3%
knew their status, of whom 96.2% were on ART, of whom 89.7% had a viral load <50copies/mL. Mean age at HIV diagnosis was 44.6±10.4 years (only 8.1% ≥70 years), people had been living with HIV for 9.8±5.0 years and had been on ART for 9.4±5.2 years. Overall, HIV was not associated with frailty: adjusted odds ratio (aOR) 0.99 (95%CI:0.42-2.33) for frailty versus non-frailty. However, each 5-years lived with HIV was associated with twice the odds of frailty/pre-frailty (aOR 2.03 [1.03-4.13]), independent of age and ART duration. Furthermore, each 5-years of ART use was associated with 60% lower odds of frailty/pre-frailty (aOR 0.39 [0.19-0.78]), independent of age and years lived with HIV. Older age, minimal education and poverty were associated with frailty. Frailty was associated with lower HRQoL in people both with and without HIV.

Conclusion
Reduced survival and good viral suppression may explain the lack of association between HIV and frailty. Early ART initiation could reduce future risk of frailty.