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

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.