Interventions and opportunities to enhance aging among people with HIV: a focus on frailty, sarcopenia, and intrinsic capacity.

Abstract

Antiretroviral therapy has transformed HIV into a chronic condition, resulting in a growing population of older people with HIV (PWH). This shift has been accompanied by an increased burden of age-related conditions, including frailty and sarcopenia, that compromise physical function and quality of life. Frailty and sarcopenia arise from complex biologic processes, many of which may be amplified in PWH. Recent conceptual advances emphasize intrinsic capacity (the composite of physical and mental capacities that determine functional ability) as a framework for understanding aging-related vulnerability. Emerging evidence suggests that social and structural determinants influence trajectories of intrinsic capacity and contribute to disparities in frailty risk. Geriatric-informed care models, including comprehensive geriatric assessment and the Integrated Care for Older People framework set forth by the World Health Organization, offer structured approaches to identify early declines in intrinsic capacity and guide individualized interventions. Exercise, nutrition optimization, and multidisciplinary care remain foundational strategies to mitigate frailty and sarcopenia, and emerging pharmacologic approaches targeting inflammation and metabolic dysfunction may influence aging trajectories. Integrating intrinsic capacity into HIV care may improve risk stratification and support interventions aimed at preserving function and healthy aging among PWH.