A New Frailty Syndrome:: Central Obesity and Frailty in Older Adults with the Human Immunodeficiency Virus

Objectives—To evaluate the relationships between body composition and physical frailty in community-dwelling HIV-infected older adults (HOA). Design—Cross-sectional. Setting—Academic hospital-based infectious disease clinic in Rochester NY Participants—Community-dwelling HIV-infected adults >50 years of age. Measurements—Subjective and objective measures of functional status were evaluated by using the Physical Performance Test (PPT), graded treadmill test, knee strength, gait speed, balance and Functional Status Questionnaires (FSQ). Body composition was evaluated by using Dual Energy X-ray Absorptiometry (DXA) and Magnetic Resonance Imaging (MRI). Results—We studied 40 HOA on antiretroviral therapy (with mean: age 58 years, BMI 29, CD4 569 cells/ml, duration since HIV diagnosis 17 years; 28% female and 57% Caucasian) who were able to ambulate without assistive devices. Sixty percent (25/40) of the subjects met our standard criteria for physical frailty. Both frail (FR) and non-frail (NF) subjects were comparable in age, gender, CD4 count and viral load. Compared to NF HOA, FR HOA showed impairments in PPT, peak aerobic power (VO2peak), FSQ, walking speed, balance and muscle quality. Importantly, FR HOA had greater body mass index (BMI), fat mass and truncal fat with lipodystrophy. Moreover, PPT score was inversely related to both trunk fat (r=−0.34; p=0.045) and intermuscular fat (IMF) to total fat ratio (r=−60; p=0.02) after adjusting for covariates. Conclusion—HOA represent an emerging cohort of older adults who frequently experience frailty at a much younger age compared to the general older population. Central obesity and fat redistribution are important predictors of frailty among community-dwelling HOA. These findings suggest that physical frailty in HOA may be amenable to lifestyle interventions, especially exercise and diet therapy.