FRAILTY AND PRE-FRAILTY IN A CONTEMPORARY COHORT OF HIV-INFECTED ADULTS

Objectives: To determine the prevalence of pre-frailty among HIV-infected persons and associationswith pre-frailty and frailty in this population. Design, Setting and Participants:From a contemporary,prospective observational cohort of HIV-infected persons (SUN Study), we determined, using a cross-sectionalanalytic study design, the proportions of non-frail, pre-frail, and frail persons by the respective presence of 0, 1-2, and ≥ 3 of 5 established frailty criteria: unintentional weight loss, exhaustion, physical-inactivity, weak-gripand slow-walk. We evaluated associations with pre-frailty/frailty using multivariate analysis. Results:Of 322participants assessed (79% men, 58% white non-Hispanic, median age 47 years, 95% on combinationantiretroviral therapy [cART], median CD4 + cell count 641 cells/mm3 and 93% HIV RNA < 400 copies/mL),57% were non-frail, 38% pre-frail, and 5% frail. Age increased from non-frailty through frailty. Notably,however, half of pre-frail and frail participants were < 50 years, and of those, 42% and 100%, respectively, werelong-term unemployed (versus 16% of non-frail counterparts). In multivariate analysis, pre-frail/frailparticipants were more likely to have Hepatitis C seropositivity (adjusted odds ratio [aOR] 3.24, 95% CI: 1.35-7.78), a history of AIDS-defining-illness (aOR 3.51, 95% CI: 1.82-6.76), greater depressive symptoms (aOR1.16, 95% CI:1.09-1.23), higher D-dimer levels (aOR 2.94, 95% CI:1.10-7.87), and were less likely to be whitenon-Hispanic (aOR 0.35, 95% CI: 0.20-0.61). Conclusions:Pre-frailty and frailty are prevalent in the cART eraand are associated with unemployment even among persons < 50 years. Pre-frailty appears to be an intermediatestate in the spectrum from non-frailty through frailty and our characterization of pre-frailty/frailty suggestscomplex multifactorial associations.