Risk factors of incident physical frailty in middle-aged and older people with and without HIV: evidence from the CHART cohort

Objective: This study aimed to identify risk factors for physical frailty incidence among people with HIV (PWH) and HIV-negative individuals and further explore the dynamic relationship between major chronic diseases and frailty. Methods: PWH and HIV-negative individuals aged ≥40 years from the Comparative HIV and Aging Research in Taizhou (CHART) cohort were included. Univariate and multivariate Cox regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the association between risk factors and physical frailty. Results: A total of 3,968 participants (1,279 cases and 2,689 controls) were included. Regardless of HIV status, the overall trend of physical frailty incidence density increased with age, and aging significantly elevated the risk of frailty. Central obesity (aHR=2.15, 95% CI: 1.09–4.23), hypertension (aHR=2.06, 95% CI: 1.03–4.11) and current unsuppressed HIV viral load (aHR=2.20, 95% CI: 1.01–4.80) increased the risk of frailty incident among PWH, while depression (aHR=1.93, 95% CI: 1.06–3.50) and diabetes (aHR=1.85, 95% CI: 1.18–2.90) increased the risk of frailty among HIV-negative controls. Dynamic Change analyses showed that incident depression, incident neurocognitive impairment, and persistent hypertension during a 3.18-year follow-up were associated with a higher risk of frailty among PWH. In contrast, incident depression, persistent depression, and persistent diabetes were significantly associated with frailty incidence among HIV-negative controls. Conclusions: Aging was significantly associated with a higher risk of physical frailty regardless of HIV status. Risk factors and the association between dynamic changes in major chronic diseases and frailty were different between HIV-positive and HIV-negative individuals.