The Interplay Between Frailty and Intrinsic Capacity in Aging and HIV Infection

Abstract

In the context of an emerging aging epidemic affecting people living with HIV (PLWH), we critically discuss existing data regarding two different conceptual models of aging-frailty and intrinsic capacity, respectively, both in a clinical and public health perspective. These constructs have not yet been integrated in the general population. Nevertheless, the holistic HIV care, which goes beyond the viro-immunological success, may offer an ideal setting to test a possible integration of these models in older adults living with HIV. We suggest a new framework to assess health in PLWH, shifting from an infectious disease (ID)/internal medicine approach, which includes quality of life in the definition of healthy living with HIV, to an ID/geriatric medicine approach, focused on the maintenance of functional ability in frail and geriatric PLWH.

Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV

“…The conceptualization of frailty in geriatric healthcare suggests a framework for identifying PLHIV who are at higher risk of poor health outcomes 55 . WHO's conceptualization of healthy aging as a process that is influenced by both intrinsic capacity and the environment may also provide insights, along with the related concept of functional ability, which emphasizes people's ability to do what is important to them at different stages of their lives 55,56 . Further research is needed to determine how these approaches can inform the clinical care of PLHIV.…”

Aged Persons Living with HIV and Nutritional Wellness: Analysis of 2013 South Africa-SAGE Well-Being of Older People Study (WOPS) Wave 2

“…Moreover, HIV is known to negatively impact the nutritional health of an individual in three underpinning ways including the fact that it alters the body's metabolism so that more energy, protein intake, and micronutrients are demanded and utilised [ 3 ]. In furtherance, individuals with HIV often eat less food due to loss of appetite, mouth or throat sores, pain and nausea, side effects of medication, or worsening household poverty and livelihood security, and finally, it impairs the absorption of nutrients consumed on account of diarrhea and vomiting, damaged intestinal cells, and other effects of opportunistic infections [ 3 ]. It could also mean that HIV-infected aged persons are living alone, which increases the chance of them not eating recurrently [ 9 ].…”

“…Notably, there is a biological, functional, and psychological decline and risk of disease in the process of ageing [ 2 ]. Ageing is associated with a decline in the body's capacity to respond to stress, and this makes the aged more prone to infectious diseases such as the human immunodeficiency virus (HIV) [ 3 , 4 ]. In this regard, well nutritional therapy is a vital adjunct in the care of the aged living with HIV.…”

The Lisbon patient: exceptional longevity with HIV suggests healthy aging as an ultimate goal for HIV care

“…In HIV scenario, OPLWH may present a similar viroimmunological status, but completely different health needs that require different intensity of care [14]. This approach leads to tailored interventions taking into an account management of ART and co-morbidities, social care and preservation of IC [15].…”