Frailty is a growing concern for people aging with HIV. To better understand which individuals may be more likely to develop frailty over time, the ACTG conducted an in-depth analysis using data from the HAILO study (A5322). Kristine Erlandson, MD, shared insights from the study and its implications for future research and care.
“Frailty captures aspects like energy levels, walking speed, strength, activity, and weight changes—all of which can fluctuate daily,” said Dr. Erlandson. “If we only assess frailty at a single point, we may miss meaningful changes that better reflect someone’s true health trajectory.”
The analysis included 967 HAILO participants with an average age of 52. Frailty was defined using the Fried frailty phenotype, which includes five components: (1) Weakness, (2) Low physical activity, (3) Unintentional weight loss, (4) Self-reported exhaustion, (5) Slowness
Individuals meeting three or more of these criteria were considered frail. At baseline, 55% were classified as fit, 39% as pre-frail (1–2 components), and 6% as frail. Over time, participants clustered into three distinct frailty trajectories:
- 83% remained non-frail
- 9% improved from frail to fitter states
- 8% transitioned from fit to frail
Those in the changing frailty groups were more likely to be older, female, physically inactive, and have comorbid conditions like heart disease, diabetes, and depression.
“Past analyses have shown that low physical activity and smoking are linked to frailty at baseline,” Dr. Erlandson noted. “But this study allowed us to identify factors associated with changes in frailty over time, which is key for designing prevention and intervention trials. We need to enroll the right individuals—those at risk but still able to benefit.”
Dr. Erlandson emphasized several takeaways:
- Most people aging with HIV remain non-frail, which is encouraging.
- Frailty changes were more common in women, highlighting the need to include more women in aging-related research like A5424 (HoT) and A5426 (iPACE).
- Frailty is potentially reversible. About 20% of participants had fluctuating frailty, supporting efforts to intervene before it becomes permanent.
The upcoming iPACE study will test whether the combination of dasatinib and quercetin can reduce frailty components and improve aging-related outcomes in people living with HIV aged 50 and older. These findings could mark an important step forward in addressing frailty in this population.
Predictors of Frailty Trajectories Among People with HIV
Published in AIDS, March 2025
Evelyn Iriarte 1, Heather L Smyth 2, Sarah Schmiege 3, Katherine Tassiopoulos 4, Catherine M Jankowski 1, Kristine M Erlandson 5