Canadian researchers study frailty among aging people with HIV
CATIE News
December 17, 2024
CATIE
- In a study of older Canadians with HIV, 17% were considered frail – above the Canadian average
- Researchers found no link between frailty and having a very low CD4+ count in the past
- Frail participants were less likely to be in a relationship and more likely to report loneliness
Frailty is an issue that increases with age and reduces a person’s ability to carry out everyday tasks and activities. Frailty can affect walking speed, ability to think clearly, muscle strength, and so on. In a study of people without HIV, researchers in Canada found that 8% of people over the age of 65 had some degree of frailty.
Another team of researchers in Canada, in cooperation with scientists who study aging in people with HIV in Italy, conducted a study of HIV-positive Canadians, all of whom were over the age of 65, to find out their degree of frailty. This study is called Change HIV.
Study details
A recent report from CHANGE HIV analyzed data from 439 people with HIV. Participants—92% males and 8% females—were recruited from seven clinics in British Columbia, Ontario and Quebec. Their average age upon entering the study was 70. All participants were taking HIV treatment (antiretroviral therapy, or ART), and over 99% had a suppressed viral load. The average CD4+ count was 560 cells/mm3.
Researchers used a well-validated method for assessing frailty called the Fried Frailty Phenotype.
Participants underwent routine blood tests and completed a survey on a broad range of topics.
Results
Researchers grouped people depending on their degree of frailty, as follows:
- robust (no frailty) – 21%
- pre-frail – 62%
- frail – 17%
The most common sign of frailty was weakness (in 43% of participants), followed by a low level of physical activity, and then slower-than-normal walking speed.
There was no link between having a very low CD4+ count in the past (200 cells/mm3) and a risk for being pre-frail or frail.
There was also no link between frailty and having other co-existing conditions (comorbidities).
Loneliness
As mentioned earlier, the HIV-positive participants completed a survey on a broad range of topics. Researchers found that participants who were frail were significantly more likely to not be in a relationship and to have a greater degree of loneliness than people who were not frail.
The data for this report were collected at one point in time. Studies like this provide a snapshot of what is happening to people at a specific point in time. The study is ongoing. As participants make more visits to the study clinics, more data will be collected and long-term trends can be found. As this analysis had a snapshot design (the technical term is cross-sectional), it cannot tell us whether loneliness caused frailty, or vice versa. However, it may be more complex than that. The researchers advanced potential explanations for their findings, as follows:
Survivorship bias
It is possible that people who were frail and had less than 200 CD4+ cells/mm3 had passed away and were therefore unavailable to be in the study. This might explain why there was no connection between a very low CD4+ count and a risk of frailty.
Modern ART
Compared to 25 years ago, ART today is potent and well tolerated; for some people, ART can be as simple as one pill taken once daily or injections every couple of months. The potency and ease of use of modern ART means that, on average, CD4+ cell counts are generally higher than they would have been decades ago with relatively less robust treatments.
The loss of loved ones before effective HIV treatment was available
Many people—particularly HIV-positive gay, bisexual and other men who have sex with men (gbMSM) who survived the era when there was no effective HIV treatment—likely lost partners and loved ones. If these survivors were in the study, they might be alone. Indeed, the researchers stated that 65% of participants were “single, divorced or widowed.”
What to do?
The study team stated that “it is crucial to develop supports that would address loneliness in [older people with HIV]. This would allow people to age safely in their own homes and create opportunities to make supportive housing and long-term care facilities available and inclusive for persons living with HIV.” This message needs to be taken up by policy makers and ministries of health.
Note well
Frailty is not a one-way street. It can get worse or it can partially or wholly resolve over time, depending on overall health and interventions. We look forward to longer-term data from CHANGE HIV that will hopefully reveal the trajectories of frailty.
The report may have inadvertently underestimated the rate of frailty, as certain sub-populations were not enrolled in the study, such as the following:
- those not engaged in HIV care
- those who were housebound
- those living in a long-term care facility
- those with significant physical impairment
- those with significant cognitive impairment
Most participants were male and white, and the findings from this study may not be generalizable to other populations. Hopefully, more participants will be enrolled in the future to address these issues.
—Sean R. Hosein
Resources
Canadian study explores the impact of aging on people with HIV – CATIE News
High rates of frailty seen among middle-aged and older HIV-positive people in Alberta – CATIE News
French researchers explore frailty in senior people with HIV – CATIE News
Does taking too many medications affect the health of people with HIV? – CATIE News
Frailty in Indigenous people with HIV – TreatmentUpdate 254
Canadian HIV Trials Network (CTN+)
REFERENCE:
Zhabokritsky A, Klein M, Harris M, et al. Prevalence and correlates of frailty among older adults living with HIV in the CHANGE HIV cohort. JAIDS. 2024 Nov 1;97(3):226-231.
From Canadian AIDS Treatment Information Exchange (CATIE).
This content was originally published by CATIE, Canada’s source for HIV and hepatitis C information.
Source: CATIE:
https://www.catie.ca/catie-news/canadian-researchers-study-frailty-among-aging-people-with-hiv
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