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Frailty in Indigenous people with HIV

As people with HIV live longer thanks to HIV treatment (antiretroviral therapy, ART), they become at risk for complications related to aging. In Canada, estimates are that at least 50% of people with HIV are over the age of 50, so research on aging in this population is important. One complication of aging is that people can accumulate comorbidities, which increases their risk for frailty.

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The Ontario HIV Treatment Network (OHTN) collects data from many HIV clinics in Ontario and analyzes it from time to time. Its most recent analysis involved 6,582 participants, of whom 330 (5%) were Indigenous. 

For the purposes of this analysis, the researchers made the following definitions:

  • the presence of one or two comorbidities resulted in participants being classed as pre-frail
  • the presence of three or four comorbidities meant that participants were classed as frail

Results

Overall, pre-frailty and frailty were more common in Indigenous people, as follows:

Pre-frailty

  • Indigenous people – 50%
  • non-Indigenous people – 41%

Frailty

  • Indigenous people – 9%
  • non-Indigenous people – 6%

What’s more, the research team found that, on average, Indigenous people became pre-frail four years earlier than non-Indigenous people, and they became frail five years earlier than non-Indigenous people.

In the OHTN study, females were over-represented and were more likely to become frail than males.

The researchers found that a history of injecting drugs was three times more common among Indigenous people (45%) than non-Indigenous people (16%). Furthermore, Indigenous people who injected drugs were more likely to be frail (13%) than non-Indigenous people who injected drugs (7%).

History of AIDS

Indigenous people were more likely than non-Indigenous people to have experienced AIDS at some point in the past (64% vs. 56%). Indigenous people who had experienced AIDS were more likely to experience pre-frailty and frailty than non-Indigenous people who had a history of AIDS.

Causes and underlying factors

Statistical analysis found that injection drug use increased the risk of frailty twofold. However, being Indigenous also carried a risk of frailty independently of drug use.

The OHTN researchers noted that Canada’s history of colonialism and ongoing racism against Indigenous people very likely has led to greater frailty at a younger age among this population. 

Researchers called for making models of care evolve to meet the needs of Indigenous people with HIV to “both address their needs at younger ages and in culturally responsive ways that work for them.”

The researchers need to do further analyses to understand the impact of other factors, such as smoking, on frailty risk, as many participants appeared to have a history of smoking.

—Sean R. Hosein

REFERENCE:

Bauer N, O’Brien KO, Light L, et al. Time is of the essence: clinical frailty among a cohort of Indigenous peoples aging with HIV in Ontario, Canada. 25th International Conference on AIDS, Munich, Germany, 22-26 July 2024. Abstract OAB3602.