Contemporary HIV Patients and the Frailty Syndrome: A Short Review

Mini Review

Austin J Infect Dis. 2014;1(2): 2.

Contemporary HIV Patients and the Frailty Syndrome: A Short Review

Stephen A Klotz1* and M Jane Mohler2

1Division of Infectious Disease, University of Arizona, USA

2Arizona Center of Aging, University of Arizona, USA

*Corresponding author: Klotz SA, Divisiont of Infectious Diseases, University of Arizona, 1501 N. Campbell Ave., Tucson AZ 85724 USA

Received: September 06, 2014; Accepted: October 08, 2014; Published: October 09, 2014

Abstract

Frailty is a well-known syndrome found in elderly, community dwelling people over the age of 65 years and is associated with morbidity. Frailty is also described in HIV-infected people, a patient group whose mean age is rising due to effective treatment and longer survival. Researchers are questioning whether frailty in the elderly is the same as frailty in HIV-infected people. We address this question in light of our recent findings in HIV-infected patients attending an ambulatory clinic. We found that frail HIV patients were exhausted and expended little energy; 100% were also depressed. On the other hand symptoms of sarcopenia, a hallmark of frailty in the elderly, were much less frequent.

Keywords: Frailty; Frailty phenotype; Aging; HIV; Chronic infection

Abbreviations

HIV: Human Immunodeficiency Virus; ART: Anti-Retroviral Therapy; FP: Frail Phenotype

Introduction

Humanity is into the fourth decade of pandemic HIV. The use of combination Anti-Retroviral Therapy (ART) since 1995 has led to viral control in HIV-infected patients thus, decreasing mortality and increasing survival. Consequently HIV is now a manageable chronic illness and AIDS is theoretically preventable [1]. For the past several years, clinicians have encountered aging-related issues in the care of their HIV patients, often on a daily basis. Many urban HIV clinics, like our own, have HIV-infected patients who have survived infection since the 1980s and are in their sixth, seventh and eighth decade of life. The mean age of HIV patients continues to increase [2]. Many patients experience early occurrence of common geriatric comorbidities [3].

Older non-infected adults accumulate the effects of the aging process and some become frail. Frailty was initially described as a geriatric syndrome resulting from age-related cumulative declines across multiple physiologic systems, impaired homeostatic reserve, and reduced capacity to resist stress [4]. Frailty increases vulnerability towards adverse health outcomes including falls, hospitalization, institutionalization and mortality [4]. Based on recent estimates, 7-11% of community-dwelling older persons are frail and another 40% are pre-frail [5]. In this review we discuss features of frailty as seen in elderly, community-dwelling individuals and compare it to "frailty" observed in young and old HIV-infected individuals (Table 1). Although the term, frailty, is used for both populations of individuals, elderly and HIV-infected alike, we believe frail HIV-infected individuals are different clinically than un-infected frail elderly individuals.

Citation: Klotz SA and Mohler MJ. Contemporary HIV Patients and the Frailty Syndrome: A Short Review. Austin J Infect Dis. 2014;1(2): 2.