Frailty and health-related quality of life among older people living with HIV pre- and post-COVID-19 pandemic onset: A cross-sectional study

Abstract

Background: Antiretroviral therapy increased the survival and life expectancy of people living with HIV (PWH). HIV infection may have an impact on the aging process, including frailty development. Frailty-related syndromes among older PWH (aged 50 years or older) may affect their health-related quality of life (HQoL). Additionally, the COVID-19 pandemic has impacted health-related outcomes, including frailty and HQoL. This study aimed to estimate the prevalence of frailty and pre-frailty among older PWH, and to explore associations of HQoL with the study assessment period and frailty status. Methods: Cross-sectional study conducted pre- (May 23, 2019 to March 5, 2020) and post-COVID-19 pandemic onset (June 23, 2021 to May 5, 2022), among older PWH at INI-Fiocruz, the largest cohort of PWH in Rio de Janeiro, Brazil. We measured frailty using a modified version of Fried assessment, consisting of five domains: (1) unintentional weight loss; (2) self-reported exhaustion, (3) weakness (grip strength), (4) slow walking speed, (5) low physical activity. QoL was assessed using the ACTG SF-21, which contains 21 questions divided into 8 domains. We used chi-square test, Fisher's exact test, Kruskal-Wallis and ranksum test for comparisons. Results: Between May 2019 and May 2022, 250 individuals were included in this analysis: 109 (43.6%) pre-COVID-19 and 141 (56.4%) post-COVID-19. The median age was 60 years (IQR:55-64). Most self-identified as cisgender men (152; 60.8%), Pardo or Black (146; 58.4%), with completed secondary education or less (169; 67.9%) and low income (132; 52.8%). Prevalences of frailty and pre-frailty were 9.2% (95%CI:8.1-10.3) and 61.6% (95%CI:54.0-69.2), while frailty prevalences were 10.6% and 7.3% in the post- and pre-COVID-19 pandemic periods, respectively. HQoL was lower among older PWH with frailty compared to those with non-frailty and pre-frailty. HQoL was also lower among older PWH included in the post-COVID-19 compared to pre-COVID-19 pandemic periods for four out of eight QoL domains. Conclusions: We observed low prevalence of frailty, but high prevalence of pre-frailty among older PWH. Our study increases the body of knowledge about aging and HIV and underscores the importance of including frailty and HQoL during clinical assessment, especially after the COVID-19 pandemic.