Prevalence and risk factors of cognitive frailty in people with HIV.

Background: Cognitive frailty (CF, the simultaneous presence of frailty and cognitive impairment) is recognized as a significant predictor of several adverse health outcomes. The objective of this study was to describe prevalence and risk factors for CF in people with HIV (PWH) >50 years.

Methods: This was a cross-sectional observational study including PWH attending Modena HIV Metabolic Clinic (MHMC). Neurocognitive function was measured with Cogstate battery that comprises six domains. Each individual CogState raw score was transformed into z-score after correction for age and sex. Neurocognitive impairment was defined by total global deficit score >0.5. Frailty was assessed by 37-Item frailty index. Scores <0.25 were considered fit or >0.26 as frail.

Results: A total of 1258 PWH were included, 916 (73%) were males, median age was 58 years, median time since HIV diagnosis was 27 years. The sample was divided into four groups (CF) based on the presence of frailty (F) and cognitive impairment (ICT): F + /ICT + , F + /ICT-, F-/ICT + , F-/ICT-. Age per 5-year increase (OR = 1.27, CI: 1.02-1.55, p = 0.022), nadir CD4 cell count (OR = 0.81, CI: 0.66 - 0.99, p = 0.042) and polypharmacy (OR = 3.47, CI: 2.00 - 6.00, p<0.001) were associated with CF after adjustment for time since HIV diagnosis, multimorbidity, depression and cumulative exposure to dolutegravir.

Conclusion: CF prevalence in PWH >50 years was 6.8% and it is higher than what has been observed in the general population >65 years (1-4.4%). Nadir CD4 cell count and polypharmacy was associated with CF, suggesting an HIV specific contribution related to the development of this condition.