Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.
MRC Unit for Lifelong Health and Ageing at UCL, London, UK.
Curr Opin Infect Dis. 2022 Feb 1;35(1):21-30. doi: 10.1097/QCO.0000000000000798.
The HIV population is ageing with rising rates of frailty though strategies of how best to manage it remain ill-defined. It also remains unclear what the prevalence of frailty is within this cohort, how best to diagnose it and what factors are associated.
The prevalence of frailty remains unclear because of heterogenous results. Routine screening in those 50+ is recommended and whilst the Fried Frailty Phenotype is currently preferred the Clinical Frailty Scale could be considered. No biomarkers are currently recommended. Looking at associated factors, HIV neurocognitive impairment and long-term alcohol usage has been shown to be associated with developing frailty whilst those who are frail have been shown to be less active and more likely to fall. NAFLD with fibrosis has been shown to be an indicator of metabolic age and the Pooled Cohort Equations has been shown to be more effective in diagnosing cardiovascular risk in frail people living with HIV.
Whilst the prevalence of frailty differs between countries, with the addition of prefrailty, this represents a large proportion of people living with HIV. Services must ensure strategies are in place to support those living with HIV and frailty. Further longitudinal studies are required.
HIV 人群正在老龄化，衰弱的发生率也在上升，但如何最好地管理衰弱的策略仍不明确。目前仍不清楚在这一人群中衰弱的患病率是多少，如何最好地诊断衰弱，以及哪些因素与之相关。
由于结果存在异质性，衰弱的患病率仍不清楚。建议对 50 岁以上的人群进行常规筛查，目前首选 Fried 衰弱表型，但也可以考虑临床衰弱量表。目前不推荐使用生物标志物。研究相关因素，HIV 神经认知障碍和长期饮酒与衰弱的发生有关，而衰弱的人活动量较少，更容易摔倒。伴有纤维化的非酒精性脂肪性肝病（NAFLD）被认为是代谢年龄的一个指标，Pooled Cohort Equations 被证明在诊断 HIV 感染者衰弱人群的心血管风险方面更有效。
尽管衰弱的患病率在不同国家有所不同，但加上前驱衰弱，这代表了很大一部分 HIV 感染者。服务机构必须确保制定策略来支持 HIV 感染者和衰弱人群。还需要进一步的纵向研究。
