title: Frailty in HIV-infected adults in South Africa.
abstract: OBJECTIVE
  Some evidence suggests that HIV infection is associated with premature frailty-a syndrome typically viewed as being related to ageing. We determined the prevalence and predictors of frailty in a population of HIV-infected individuals in South Africa.
  
  
  METHODS
  Case-control study of 504 adults more than the age of 30 years, composed of 248 HIV-infected adults and 256 age- and gender-matched, frequency-matched HIV-seronegative individuals.
  
  
  METHODS
  Frailty was defined by standardized assessment comprised of ≥ 3 of weight loss, low physical activity, exhaustion, weak grip strength, and slow walking time. Independent predictors of frailty were evaluated using multivariable logistic regression.
  
  
  RESULTS
  The mean ages of the HIV-infected and HIV-seronegative groups were 41.1 ± 7.9 years and 42.6 ± 9.6 years, respectively. Of the HIV-infected adults, 87.1% were receiving antiretroviral treatment (median duration, 58 months), their median CD4 count was 468 cells/μL (interquartile range = 325-607 cells/μL) and 84.3% had undetectable plasma viral load. HIV-infected adults were more likely to be frail than HIV-seronegative individuals (19.4% vs. 13.3%; P = 0.07), and this association persisted after adjustment for confounding variables [adjusted OR = 2.14; 95% confidence interval (95% CI): 1.16-3.92, P = 0.01]. Among HIV-infected individuals, older age was a strong predictor of frailty, especially among women (women: OR = 2.55 per 10-year age increase; men: OR = 1.29 per 10-year age increase, P-interaction = 0.01). Lower current CD4 count (<500 cells/μL) was also independently associated with frailty (OR = 2.84; 95% CI: 1.02 -7.92, P = 0.04).
  
  
  CONCLUSIONS
  HIV infection is associated with premature development of frailty, especially in women. Since higher CD4 counts were associated with lower risk of frailty, earlier initiation of antiretroviral treatment may be protective.
authors.affiliation: International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom. sophia.pathai@lshtm.ac.uk
authors.forename: Sophia
authors.initials: S
authors.lastname: Pathai
authors.forename: Clare
authors.initials: C
authors.lastname: Gilbert
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.forename: Colin
authors.initials: C
authors.lastname: Cook
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000453:epidemiology*; D012737:Sex Factors; D013019:South Africa