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Faces of Frailty in Aging with HIV Infection

  • Behavioral-Bio-Medical Interface (JL Brown and RJ DiClemente, Section Editors)
  • Published:
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Abstract

Purpose of the Review

The number of adults who are aging successfully and have HIV infection is increasing. More effective antiretroviral therapy (ART) regimens are preventing individuals infected with HIV from reaching end stages of the HIV infection and developing AIDS (acquired immunodeficiency syndrome). However, even at lower viral loads, chronic HIV infection appears to have consequences on aging processes, including the development of frailty.

Recent Findings

Frailty is a term used to describe vulnerability in aging. Frailty indices such as the Fried Frailty Index (FFI), the Veterans Aging Cohort Study (VACS) Index, and the Center for Epidemiologic Studies Depression scale (CES-D), an index of emotional frailty, associate with or predict clinical outcomes and death. However, even among existing frailty definitions, components require rigorous and consistent standardization. In the Women’s Interagency HIV Study (WIHS), we have shown that frailty does not exist in isolation, even in midlife, and we use frailty to predict death.

Summary

Frailty indices should be systematically used by health professionals to evaluate health and future risks for adverse events. Frailty prevention efforts, especially among those with HIV infection, appear to be essential for “successful aging” or aging without disability or loss of independence and may prevent HIV transmission. Taking care of elderly people is one of the major challenges of this century, and we must expect and be prepared for an increase in the number of aging adults, some of whom are patients with many co-morbidities and HIV infection.

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Acknowledgements

The authors would like to acknowledge the following: State University of New York Downstate Medical Center institutional research support; the Women’s Interagency HIV Study (WIHS) Collaborative Study Group with centers (Principal Investigators) at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff, Deborah Gustafson); Washington DC, Metropolitan Consortium (Mary Young); the Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); and the Data Coordinating Center (Stephen Gange). The WIHS is funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590) and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (UO1-HD-32632). The study is co-funded by the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders. Funding is also provided by the National Center for Research Resources (UCSF-CTSI Grant Number UL1 RR024131).

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Authors and Affiliations

  1. Department of Neurology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY, 11203, USA

    Marion Thurn & Deborah R. Gustafson

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  1. Marion Thurn
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Correspondence to Deborah R. Gustafson.

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All aspects of this review are compliant with the ethical guidelines enforced by the State University of New York Downstate Medical Center, USA.

Conflict of Interest

Marion Thurn and Deborah R. Gustafson have no conflicts of interest to declare.

Human and Animal Rights and Informed Consent

This article contains reference to human research studies, some performed by Dr. Gustafson. All studies cited or conducted within the WIHS are approved by ethical review boards at each WIHS site. The Institutional Review Boards of each WIHS site have reviewed and approved all data collection and analyses for the WIHS.

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The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

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Thurn, M., Gustafson, D.R. Faces of Frailty in Aging with HIV Infection. Curr HIV/AIDS Rep 14, 31–37 (2017). https://doi.org/10.1007/s11904-017-0348-x

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