# The Performance of a New Multidimensional Frailty Index in Comparison to the Frailty Phenotype to Assess Frailty in People Living with HIV 50 Years of Age and Older in an Urban HIV Clinic

## TL;DR

A new frailty index better identifies frailty in older HIV patients compared to the traditional frailty phenotype, showing stronger clinical associations.

## Contribution

A new 40-variable clinical composite frailty index (CCFI) was developed and validated for older people living with HIV.

## Key findings

- The CCFI identified 26% of participants as frail, compared to 2% using the frailty phenotype.
- CCFI frailty was significantly associated with cognition, falls, polypharmacy, and comorbidities.
- The CCFI showed stronger clinical relevance and identified more patients as frail than the traditional frailty phenotype.

## Abstract

Frailty is increasingly recognized in older people living with HIV (PLWH), but optimal diagnostics are yet to be determined. Frailty indices (FI) represent an accumulation of health deficits shown to correlate better with mortality and adverse effects of aging than the frailty phenotype or chronological age.

This is a retrospective cohort study of frailty assessments in PLWH aged ≥ 50 years in a multidisciplinary urban HIV clinic. Frailty was assessed using Frailty Phenotype (FP) and a new 40-variable clinical composite FI derived from routine clinical and laboratory data (CCFI). CCFI scores were categorized into robust (≤ 0.15), pre-frail (>0.15-0.4), and frail (>0.4). CCFI frailty and its association with frailty-related factors were analyzed using logistic regression.

The 165 participants were mostly black (94%) and male (56%), with median age 59 years (IQR 55-63), CD4 count 606 cells/μl (IQR 393-873), and 78% had HIV viral load ≤ 40 copies/ml. 70% had multimorbidity, 38% falls, 25% poor cognition, and 24% polypharmacy. By FP, 2% were frail, 65% prefrail, and 33% robust. By CCFI, 26% were frail, 67% prefrail, and 7% robust (range 0.08-0.57; mean 0.34 ±0.11). For FP categorized as robust, prefrail and frail, the mean CCFI was 0.31 ± 0.1, 0.35 ± 0.11 and 0.38 ± 0.08 respectively (P=0.06). Cognition (OR 3.64, p=0.003), falls (OR 5.09, p<0.001), polypharmacy of 6-9 medications (OR 3.07, p=0.03) and ≥ 10 medications (OR 4.25, p=0.009) and >3 comorbidities (OR 3.06, p=0.03) were associated with CCFI frailty, adjusted for age and sex.

The majority of older PLWH were pre-frail or frail. The CCFI identified more patients as frail and had significant clinical associations compared to FP.