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. Author manuscript; available in PMC: 2020 Feb 1.
Published in final edited form as: AIDS. 2019 Feb 1;33(2):357–359. doi: 10.1097/QAD.0000000000002047

Prevalence and one-year incidence of frailty among women with and without HIV in the Women’s Interagency HIV Study

Terra V FATUKASI a, Andrew EDMONDS a, Deborah R GUSTAFSON b, Stephen R COLE a, Jessie K EDWARDS a, Hector BOLIVAR c, Mardge COHEN d, Margaret A FISCHL e, Stephen GANGE f, Deborah KONKLE-PARKER g, Caitlin A MORAN h, Michael PLANKEY i, Anjali SHARMA j, Phyllis C TIEN k, Adaora A ADIMORA a,l
PMCID: PMC6487202  NIHMSID: NIHMS1512741  PMID: 30562174

A previous cross-sectional analysis of 2,028 women in the Women’s Interagency HIV Study (WIHS), who were on average 39 years old, found 17% and 10% frailty prevalence in women with, or at risk for, HIV, respectively[1]. To our knowledge, the only two longitudinal studies of frailty among people with HIV were conducted in the Multicenter AIDS Cohort Study (MACS), which includes only men[2, 3]. Data on the distribution of frailty components are limited, and have not been reported for HIV-seropositive people in the US[4–7].

The current analysis included data from eight WIHS sites located in Brooklyn, NY; San Francisco, CA; Chicago, IL; Washington, DC; Atlanta, GA; Chapel Hill, NC; Miami, FL; and Birmingham, AL/Jackson, MS[8–10]. Institutional review board approval was obtained at each site and written informed consent was obtained from all women. The study sample included 1,404 women ≥ 40 years old who had ≥ 1 frailty assessment between October 1, 2015 and September 30, 2017. Of the 1,404 women, 424 had frailty assessments taken at both baseline and approximately a one-year period of follow-up; 46 women were excluded due to frail status at baseline and 378 women were included in analyses estimating the one-year risk of frailty.

Since October 1, 2015, the WIHS protocol has included the measurement of frailty components and determined frailty status among women ≥ 40 years old. The Fried Frailty Index, a tool validated in the Cardiovascular Health Study, was used to operationalize the frailty phenotype based on five components: weakness, slowness, unintentional weight loss, low activity, and exhaustion[4]. Frail, pre-frail, and robust statuses were defined as exceeding the component-specific threshold for ≥ 3 frailty components, 2 frailty components, and ≤ 1 frailty component, respectively[4]. We used the cut points for walking speed and grip strength validated by Fried, unlike previous analyses which used the highest and lowest quintiles of the distributions from their HIV-seronegative populations[1–4].

The median age was 52 years (interquartile range [IQR]: 47, 57) for both women with HIV (n=1,025) and without HIV (n=379). Most women were black non-Hispanic (75%[n=1,055]), had at least a high school education (70%[n=977]), and had an annual household income ≤$18,000 (63%[n=876]). The prevalence of current smoking (47%[n=177]; 38%[n=392]), weekly alcohol consumption >7 drinks (19%[n=73]; 6%[n=65]), and other substance use (34%[n=128]; 25%[n=252]) was higher among women without HIV than women with HIV. Among women with HIV, 71% (n=732) had an undetectable viral load.

The overall prevalence of frailty was 11.5% (n=161/1,404); 10.0% (n=103/1,025) among women with HIV and 15.3% among women without HIV (n=58/379). Frailty prevalence was higher for women without HIV compared to women with HIV for all age groups except 55–59 years (Figure 1A). Low physical activity was the most frequently occurring frailty component (Figure 1B). The prevalence of frailty components was similar for women with and without HIV, except that it was more common for women with HIV to report unintentional weight loss and for women without HIV to meet the definition for weakness for each frailty category (Figure 1B). The most common combinations of frailty components were similar in women with and without HIV and included low physical activity and exhaustion for pre-frail women (67%[n=252]), and these components in combination with one other component for frail women (68%[n=110]). The prevalence of current smoking (41%[n=41]; 41%[n=113]), weekly alcohol consumption >7 drinks (18%[n=18]; 9%[n=26]), and other substance use (31%[n=31]; 22%[n=60]) was more balanced between women without HIV (n=101) and women with HIV (n=277) in the risk sample as compared to the prevalence sample. The overall one-year risk of frailty was 6.6% (95% confidence interval: 4.1, 9.1) and similar for women with (6.5%[n=18]) and without HIV (6.9%[n=7]).

Figure 1.

Figure 1.

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Prevalence of Frailty (A) and Distribution of Frailty Components (B) in the Women’s Interagency

HIV Study by Frailty Status and HIV Status 2015–2017 (n=1,404).

Note for Figure 1B. The height of each bar represents the percentage of participants reporting each frailty component and the value above each bar represents the number of participants.

Previous general population studies suggest that frailty is associated with older age, female gender, minority race/ethnicity, lower socioeconomic status, geographic location, comorbidities, poor nutrition, smoking, and possibly alcohol consumption[1, 4, 11–14]. To ensure comparability to HIV-seropositive women, the WIHS preferentially recruited HIV-seronegative women with characteristics that are associated with an increased risk of HIV infection, such as injection drug use[9]. Several of these risk characteristics are highly prevalent in the WIHS population[10]; some were more prevalent among women without HIV in our sample. Our findings suggest that social and behavioral risk factors could play a pivotal role in frailty occurrence among HIV-seropositive women with or those who are seronegative but at risk for HIV infection. Future studies should investigate modifiable risk factors to reduce the burden of frailty among women with and without HIV, who are vulnerable to frailty at ages even younger than 65.

Acknowledgements

The Women’s Interagency HIV Study (WIHS) is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). WIHS (Principal Investigators): UAB-MS WIHS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos and Anjali Sharma), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR000454 (Atlanta CTSA), and P30-AI-050410 (UNC CFAR). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH).

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