# Exploring frailty in the context of HIV and aging in Kazakhstan: findings from a pilot cross-sectional study

## TL;DR

This pilot study in Kazakhstan finds that frailty affects 13% of middle-aged and older people living with HIV, with psychosocial factors and multiple chronic conditions being key contributors.

## Contribution

The study is the first to explore frailty prevalence and its determinants among people living with HIV in Kazakhstan and Central Asia.

## Key findings

- Frailty prevalence was 13%, and 40% met criteria for prefrailty/frailty among PLHIV in Kazakhstan.
- Multimorbidity, depressive symptoms, and HIV-related stigma were strongly associated with frailty.
- HIV-specific indicators like CD4 count and viral load were not significantly linked to frailty.

## Abstract

Frailty is increasingly recognized as an important morbidity among people living with HIV (PLHIV). However, no published data exist on its prevalence or determinants in Kazakhstan or Central Asia. This pilot study aimed to provide preliminary estimates of frailty prevalence and its associated factors among PLHIV in Almaty, Kazakhstan.

We conducted a cross-sectional pilot study at the Almaty Centre for AIDS Prevention and Control. A total of 100 PLHIV aged 40 years and older were recruited during routine clinical visits from a previous pilot study on cardiovascular health. Frailty was assessed via the Fried frailty Phenotype that included slow gait speed, weak grip strength, exhaustion, low physical activity, and unintentional weight loss. Participants meeting three or more criteria were classified as frail, and those meeting two or more criteria were classified as prefrail/frail. Logistic regression models were used to examine associations of prefrailty/frailty with HIV-related factors, multimorbidity (≥ 3 chronic conditions other than HIV), depressive symptoms, HIV-related stigmas, and expectations regarding aging.

The participants had a mean age of 50 years (SD 7.9), and 58% were male. The prevalence of frailty was 13%, whereas 40% met the criteria for prefrailty/frailty. Multimorbidity (adjusted odds ratio [AOR] 3.44, 95% confidence interval [CI] 1.40–8.79), depressive symptoms (AOR 1.09, 95% CI 1.02–1.19), internalized HIV-related stigma (AOR 1.25, 95% CI 1.05–1.56), and clinic-based HIV stigma (AOR 1.57, 95% CI 1.18–2.10) were associated with greater odds of prefrailty/frailty. Neurological, endocrine/metabolic, and noninfectious respiratory conditions were also significantly associated with the outcome. HIV-specific indicators such as the CD4 count and viral load were not significantly associated.

Frailty is present among middle-aged and older PLHIV in Kazakhstan. Psychosocial factors and multimorbidity were more strongly associated with frailty than were HIV-specific indicators. As a pilot study with a modest sample size, these findings should be interpreted as preliminary but emphasize the need for larger-scale studies and interventions addressing frailty among PLHIV in the region.