Frailty Transition Among Older Adults Living With HIV in Thailand: A 5-Year Longitudinal Study

IF 4.9 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2026-04-01 DOI:10.1002/jia2.70099

Tanakorn Apornpong, Win Min Han, Akarin Hiransuthikul, Hay Mar Su Lwin, Napon Hiranburana, Sasiwimol Ubolyam, Stephen J. Kerr, Thira Woratanarat, Anchalee Avihingsanon, HIV-NAT 006 and 207 study team

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引用次数: 0

Abstract

Introduction

Frailty is highly prevalent among older people with HIV (PWH), driven by multimorbidity and HIV-associated accelerated ageing. We investigated frailty transitions and associated factors over a 5-year follow-up period in an ageing cohort of PWH in Thailand.

Methods

We conducted a prospective cohort study among PWH aged ≥50 years in Bangkok, Thailand, between May 2015 and June 2024. Frailty phenotypes were assessed at baseline and at 5 years of follow-up using the Fried frailty phenotype, including unintentional weight loss, low physical activity, exhaustion, weak grip strength and slow walking speed. Multinomial logistic regression was performed to identify factors associated with frailty progression and reversibility over follow-up.

Results

Among 324 participants enrolled (63% male; median age of 54 [IQR, 52−59] years), 158 (49%) were robust, 153 (47%) were pre-frailty and 13 (4%) were frailty at baseline. Over 5 years, 111 participants (34%) experienced frailty worsening, 158 (49%) remained stable and 55 (17%) demonstrated frailty reversal. Among 158 PWH who were robust at baseline, 75 (47%) remained robust, 57 (36%) transitioned to pre-frailty and 26 (16%) progressed to frailty. Notably, among those frail at baseline (N = 13), 65% improved to pre-frailty or robustness. Low physical activity was the most common frailty component at baseline, while weak grip strength was the most predominant frailty phenotype at year 5. In multivariable analysis, multimorbidity (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI]: 1.42−6.72, p = 0.004), antiretroviral therapy (ART) duration>20 years (aOR 1.82, 95% CI: 1.08−3.06, p = 0.025) and baseline vitamin D deficiency (aOR 1.85, 95% CI: 1.10−3.10, p = 0.019) were independently associated with increased frailty over the 5-year follow-up. Conversely, multimorbidity (aOR 0.44, 95% CI: 0.44 [0.23−0.84], p = 0.013) and CD4 counts< 500 cells/mm³ (aOR 0.25, 95% CI: 0.10−0.62, p = 0.003) were associated with a lower likelihood of frailty reversal.

Conclusions

Frailty among PWH aged ≥50 years in Thailand was common and highly dynamic, with over half of frail participants improving over 5 years. Multimorbidity, prolonged ART exposure and vitamin D deficiency were key predictors of frailty progression, whereas CD4< 500 cells/mm³ and multimorbidity reduced the likelihood of frailty reversal. These findings highlight frailty as modifiable and support integrating routine frailty screening and geriatric-informed care into long-term HIV services.

Clinical Trial Registration

NCT00411983

Abstract Image

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泰国老年艾滋病毒感染者的衰弱过渡：一项为期5年的纵向研究。

简介：虚弱在老年艾滋病毒感染者（PWH）中非常普遍，这是由多种疾病和艾滋病毒相关的加速衰老所驱动的。我们对泰国一个老年PWH队列进行了为期5年的随访，调查了衰弱转变和相关因素。方法：我们于2015年5月至2024年6月在泰国曼谷对年龄≥50岁的PWH进行了一项前瞻性队列研究。虚弱表型在基线和5年随访时使用Fried虚弱表型进行评估，包括意外体重减轻、体力活动减少、疲惫、握力弱和步行速度慢。采用多项逻辑回归来确定与随访期间衰弱进展和可逆性相关的因素。结果：在纳入的324名参与者中（63%为男性，中位年龄54岁[IQR， 52-59]岁），158名（49%）健康，153名（47%）处于虚弱前期，13名（4%）处于虚弱基线。在5年的时间里，111名参与者（34%）出现虚弱恶化，158名（49%）保持稳定，55名（17%）表现出虚弱逆转。在158名基线时健康的PWH中，75名（47%）保持健康，57名（36%）过渡到虚弱前，26名（16%）进展到虚弱。值得注意的是，在基线虚弱者（N = 13）中，65%的人改善到虚弱前或健壮。低体力活动是基线时最常见的虚弱因素，而握力弱是第5年最主要的虚弱表型。在多变量分析中，多发病（校正优势比[aOR] 3.09, 95%可信区间[CI]: 1.42-6.72, p = 0.004）、抗逆转录病毒治疗（ART）持续时间bbb20年（aOR 1.82, 95% CI: 1.08-3.06, p = 0.025）和基线维生素D缺乏症（aOR 1.85, 95% CI: 1.10-3.10, p = 0.019）与5年随访期间虚弱程度增加独立相关。相反，多发病（aOR 0.44, 95% CI: 0.44 [0.23-0.84], p = 0.013）和CD4计数< 500细胞/mm3 （aOR 0.25, 95% CI: 0.10-0.62, p = 0.003）与较低的衰弱逆转可能性相关。结论：泰国年龄≥50岁的PWH患者中，虚弱是常见且高度动态的，超过一半的虚弱参与者在5年内改善。多病、长期抗逆转录病毒治疗和维生素D缺乏是衰弱进展的关键预测因素，而CD4< 500细胞/mm3和多病降低了衰弱逆转的可能性。这些发现强调虚弱是可以改变的，并支持将常规虚弱筛查和老年知情护理纳入长期艾滋病毒服务。临床试验注册：NCT00411983。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.