Prevalence and clinical correlates of frailty among adults with HIV infection and unhealthy alcohol or drug use

OBJECTIVE: Unhealthy alcohol and/or other drug use (substance use) may increase the risk of frailty among people with HIV (PWH), a population already at higher risk of frailty. A better understanding of conditions associated with frailty among PWH with substance use is needed to guide management of frailty in these patients. The study objectives were to identify the prevalence and clinical correlates of frailty among PWH with a history of substance use. DESIGN: Cross-sectional. METHODS: We compared clinical characteristics of frail, prefrail, and nonfrail (Fried's phenotype) PWH and a history of substance use using Kruskal-Wallis (for continuous variables) or chi-square (for categorical variables). RESULTS: Among 250 participants with mean age of 52 years, most were frail (n = 68, 27%) or prefrail (n = 148, 59%). HIV viral load was well controlled with no differences between frailty groups. More frail participants had impaired physical functioning (90%), pain interference (71%), at least 1 fall (53%), and tobacco use (82%) compared to prefrail and nonfrail participants. Past-year alcohol (49%) and cocaine (40%) use disorders and overdose [lifetime (44%) and past-year (16%)] were also more common among frail compared to prefrail and nonfrail participants. CONCLUSION: Frailty and prefrailty were highly prevalent among people with stable HIV and a history of unhealthy substance use. Care for frail and prefrail PWH should address modifiable factors including overdose, pain, falls, as well as management of substance use disorders. Understanding the clinical and addiction-related experiences of frail PWH is critical for the care of this vulnerable population.