Frailty assessment in older people with HIV: A narrative review

Frailty is increasingly recognized as a major geriatric syndrome among people living with HIV (PLHIV). It is driven by accelerated biological aging, multimorbidity, and the early onset of other geriatric syndromes, despite the effectiveness of antiretroviral therapy. This narrative review describes the assessment of frailty in PLHIV aged 50 years and older and summarizes its use as a clinical outcome and predictor of adverse events. A literature search in PubMed (2015-2026) identified 63 eligible studies from North America, Latin America, Europe, Africa, and Asia. At least thirteen frailty instruments were used, with Fried's Frailty Phenotype predominating along multidimensional or context-adapted tools, such as the Frailty Index, the Veterans Aging Cohort Study Index, the FRAIL scale, the Edmonton Frailty Scale, the Tilburg Frailty Indicator, and African and Asian adaptations. Most studies operationalized frailty as an outcome and found consistent associations with multimorbidity, advanced age, depressive symptoms, female sex, polypharmacy, and social vulnerability. When examined as a predictor, frailty was independently associated with cognitive decline, poorer quality of life, all-cause mortality, falls, nonadherence to antiretroviral therapy, and reduced physical activity. However, marked methodological heterogeneity limits direct comparison across settings and underscores the need for validated, multidimensional, and context-appropriate measures tailored to PLHIV.