Comparison of four frailty scores to predict adverse health events and mortality in people living with HIV aged 70 years and more ( ANRS EP 66 SEPTAVIH study)

INTRODUCTION: As people living with HIV age, frailty has emerged as a determinant of adverse health outcomes. We evaluated four frailty assessment tools in their ability to predict adverse health outcomes and mortality in people living with HIV. METHODS: We enrolled 508 people living with HIV aged ≥70 years. At baseline, frailty was assessed using the Fried frailty phenotype, the FRAIL scale, the Study of Osteoporotic Fractures (SOF) score and the French Health Authority (HAS) questionnaire. The primary outcome was adverse health events (serious or recurrent falls, emergency department visits, unscheduled hospitalizations, nursing home admission or death) over 36 months. Log-binomial regression models estimated relative risks (RRs) for adverse outcomes in the 355 participants with a 36 months visit follow-up or death. Cox proportional hazards models assessed mortality in all enrolled people living with HIV. RESULTS: Over 36 months, 204 participants (40.2%) experienced our primary outcome, including 40 deaths. Frailty was associated with a higher risk of adverse outcomes with all tools: Fried phenotype [RR 1.41, 95% confidence interval (CI) 1.06-1.86], FRAIL scale (RR 1.88, 95% CI 1.54-2.29), SOF score (RR 1.45, 95% CI 1.05-2.00) and HAS questionnaire (RR 1.64, 95% CI 1.40-1.92). All tools were strongly associated with mortality, except the SOF score. CONCLUSIONS: In people living with HIV aged ≥70 years, all four frailty tools predicted adverse health outcomes, whilst mortality was best predicted by the Fried phenotype, FRAIL scale and HAS questionnaire. Simple, questionnaire-based tools such as the FRAIL scale and the HAS questionnaire offer practical and effective frailty screening tools in routine HIV care for older adults.