Multidimensional Assessment of Aging with HIV in Algeria: Frailty, Cognitive Decline, and Comorbidity in a Cohort of Adults Aged 50 and Over

Background: As antiretroviral therapy (ART) prolongs life expectancy, aging with HIV is no longer exceptional but increasingly prevalent. However, in resource-limited settings, particularly in North Africa, the multidimensional vulnerability of older people living with HIV (PLWH) remains poorly characterized. This study aimed to assess frailty, comorbidities, cognitive impairment, and overall clinical complexity among aging PLWH in Algeria using standardized geriatric and HIV-specific indicators. Methods: We conducted a retrospective cross-sectional study of 436 PLWH aged ≥50 years, followed between 2005 and 2025 at the University Hospital of Sétif, Algeria. Clinical and laboratory data were extracted to evaluate four validated scores: the Fried frailty phenotype, Mini-Mental State Examination (MMSE), Charlson Comorbidity Index (CCI), and a simplified version of the Veterans Aging Cohort Study (VACS) Index. Analyses included descriptive statistics and cross-tabulations using SPSS® and Excel®. Results: The mean age was 62.6 ± 6.2 years, with 65.6% being male. Frailty affected 25% of participants, while 41% were pre-frail. Cognitive impairment (MMSE <24) was observed in 21.8%, and 43.8% had a CCI ≥5. The mean VACS Index was 23.4, with 39% of patients having a score greater than 20, indicating an increased mortality risk. Hypertension (55%), type 2 diabetes (33%), dyslipidemia (31%), and thyroid disorders (24%) were the most common comorbidities. Chronic kidney disease affected 9%, and 2.8% had non-AIDS-defining cancers. Cross-score analysis revealed substantial overlap between frailty, cognitive impairment, and comorbid burden. Conclusion: These findings highlight the need for geriatric-focused care models and ART optimization tailored to aging PLWH in low- and middleincome settings.