People living with HIV (PLHIV) now have life expectancy comparable to the general population, resulting in an increased number of older adults and aging-related comorbidities such as frailty and HIV-associated neurocognitive disorders (HAND). Despite international recommendations for annual screening, there is no consensus on ideal tools, and implementation in clinical practice remains limited. This study aimed to identify frailty and HAND in PLHIV aged > 50 years and potential associated factors. In this prospective cohort, 43 PLHIV aged > 50 years on antiretroviral therapy (ART) were included at a referral center in the interior of São Paulo between May 2024 and April 2025. Clinical and sociodemographic data were collected. Frailty was assessed by the Fried Phenotype; functional capacity by the Katz Index of activities of daily living (ADL); geriatric depression by the GDS-15; and HAND screening by the International HIV Dementia Scale (IHDS). Overall, 56% were women and mean age was 61 years. Most (90.7%) had undetectable viral load. Mean time since HIV diagnosis was 21 years. A total of 32.5% of patients were classified as non-frail, 62.7% as pre-frail, and 4.6% as frail. Among the pre-frail, most had low schooling and were retired. There was no association between frailty and HAND. Risk of depression was identified in 23.2%, especially among younger women (50–60 years) with low schooling and income, and showed significant association with pre-frailty (p = 0.012). Cognitive screening indicated risk for HAND in 67.7% (IHDS ≤ 10), especially among those with lower schooling, low income, dyslipidemia, and overweight. Only one patient had functional limitation in ADLs. There was no association between HAND and prior opportunistic diseases, CD4 nadir, or alcohol/drug use. Despite virologic suppression, there was a high prevalence of pre-frailty, risk of depression, and neurocognitive impairment, particularly among PLHIV with low schooling and income. The association between pre-frailty and depression highlights the need for multidisciplinary care. The preservation of functionality among cases screened for HAND suggests that systematic screening may help identify subclinical conditions and support prevention.
Rodrigues et al. (Sun,) studied this question.