The rising burden of frailty among people living with HIV

• What happened: New analysis highlights a growing burden of frailty and prefrailty among ageing people living with HIV.

• Why it matters: As survival improves, age-related vulnerability now threatens quality of life and healthcare systems.

• What changes for people: HIV care may need to shift from virus control alone to frailty screening, fall prevention, and healthy ageing support.

• Who is affected: Older adults with HIV, clinicians, caregivers, and public health planners.

 

Thanks to effective antiretroviral therapy, people living with HIV are ageing like never before. But with longer lives comes a quieter challenge: frailty—a condition that increases vulnerability to illness, disability, and injury, even when the virus itself is well controlled.

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What the research shows

According to a new report in the European Medical Journal, researchers modelled outcomes for adults aged 40 and above with suppressed HIV in the United States.

Using the Frailty Policy Model, the study simulated a population of about 522,000 people living with HIV.

Key findings

• Average age: 56 years

• Women: 25%

• Nearly 50% already prefrail or frail

• Projected life expectancy: just over 20 more years

• Around 12 of those years likely spent in a prefrail or frail state

Frailty, once considered an issue of very old age, is emerging much earlier in people with HIV.

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What frailty really means

Frailty is not a single disease. It is a syndrome of reduced strength, endurance, and physiological reserve.

• Increases risk of falls and fractures

• Raises likelihood of hospitalisation and disability

• Makes recovery from illness slower and harder

Prefrailty is an earlier stage—often reversible—making early detection crucial.

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Why people with HIV are at higher risk

Experts point to multiple overlapping factors:

• Chronic inflammation linked to long-term HIV infection

• Side effects of lifelong medication

• Higher rates of cardiovascular disease, bone loss, and muscle wasting

• Social factors such as stigma and limited access to geriatric care

Viral suppression alone does not eliminate ageing-related vulnerability.

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Why this matters now

Healthcare systems built around acute HIV care may be unprepared for long-term ageing needs.

• Routine HIV visits rarely screen for frailty

• Falls and functional decline raise healthcare costs

• Early intervention could preserve independence and quality of life

The challenge is shifting from survival to healthy ageing.