Abstract
There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.
Highlights
The global scale-up of combination anti-retroviral therapy has converted HIV infection from a terminal illness to a chronic disease with near-normal life expectancy
We aimed to estimate the prevalence of frailty using these three simple non-specialist measures (CFS, Fried frailty phenotype (FFP) and B-FIT 2) in a clinic-based HIV-positive cohort aged 50 and over receiving combination anti-retroviral therapy (cART) according to the 2017 Tanzanian HIV guidelines
We identified frailty using three different screening measures, but a more comprehensive and accurate method would have been to employ Comprehensive Geriatric Assessment (CGA), and future studies should compare the performance of these screening tools to CGA in order to determine the most accurate frailty screening tool for this setting
Summary
The global scale-up of combination anti-retroviral therapy (cART) has converted HIV infection from a terminal illness to a chronic disease with near-normal life expectancy. HIV infection appears to be associated with accelerated biological ageing, beyond that of HIVnegative individuals (Appay and Rowland-Jones 2002; Arnsten et al 2007; Triant et al 2007) leading to the premature expression of geriatric syndromes, such as frailty and sarcopenia (Desquilbet et al 2007, 2009; Erlandson et al 2013b; Piggott et al 2013; Willig et al 2016), for reasons that are not well understood. Frailty is a clinical syndrome of physiological vulnerability and inability to cope with internal or external stressors (Clegg et al 2013) which independently predicts multiple adverse outcomes, such as falls, disability and death (Erlandson et al 2012; Fried et al 2001). The syndrome overlaps with, but is distinct from, comorbidity, disability and physiological ageing (Yarnall et al 2017)
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