Patient selection: adult who is HIV-positive, age >= 50 years of age, without evidence of wasting or AIDS
The onset of frailty may be earlier in HIV-positive patients than in HIV-negative patients.
Criteria for mild to moderate frailty - at least 2 of the following:
(1) Physical Performance Test score of 18 to 32 (score for 9-item test ranges from 0 to 38)
(2) peak oxygen uptake of 11 to 18 mL per kg per minute
(3) difficulty or need for assistance in >= 1 activity of daily living or >= 2 instrumental activities of daily living
Phenotypic findings of obesity and fat redistribution:
(1) higher body mass index (31 +/- 8, versus 26 +/- 3)
(2) higher body fat mass (26 +/- 9 kg, versus 20 +/- 5)
(3) higher truncal fat (15 +/- 5 kg, versus 10 +/- 3)
(4) higher ratio of intermuscular fat to total fat (based on MRI imaging of the thigh)
(5) higher waist circumference (42 +/- 6 inches, versus 37 +/- 5)
There was a tendency towards a higher prevalence of the metabolic syndrome in the frail group.
Differential diagnosis:
(1) recent HIV-conversion in an older adult engaging in unprotected sex
A hypothesis is that screening for obesity and instituting exercise and dietary interventions may reduce the risk of frailty.
