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How to assess and manage frailty in patients with HIV
  1. T Levett1,
  2. J Wright2
  1. 1Department of Elderly Medicine, BSUH, Brighton, UK
  2. 2BSUH, Brighton, UK
  1. Correspondence to Dr J Wright, BSUH, Audrey Emerton Building, Brighton BN2 5BE, UK; juliet.wright{at}bsuh.nhs.uk

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As a result of the successful treatment of HIV over the last four decades, people living with HIV (PLWH) can now expect a near-normal life expectancy.1 This change in demographics, alongside later life acquisition of HIV,2 has resulted in clinical services now seeing an older HIV cohort, with patients experiencing many of the problems of an older HIV-negative cohort such as multiple medical diagnoses, polypharmacy and frailty.

An example case:

A 70-year-old man with ‘well-controlled’ chronic HIV infection, presents to his routine HIV clinic appointment complaining of recurrent falls, fatigue, low mood, self-reported memory concerns, episodes of urinary incontinence and increased difficulty looking after himself at home.

HIV background:

  • diagnosed in 1995, aged 48 years

  • initial CD4 count, 45 cells/mm3

  • late presentation with Pneumocystis jiroveci pneumonia, defining AIDS

  • started antiretroviral drugs (ARVs), 1995

  • current CD4, 556 cells/mm3, viral load undetectable

Past medical history:

  • ischaemic heart disease

  • type 2 diabetes mellitus

  • hypertension

  • peripheral neuropathy

  • depression

  • benign prostatic hypertrophy and bladder instability

Drug history:

  • Diltiazem 180 mg once a day (OD)

  • Bendroflumethiazide 2.5 mg OD

  • Gabapentin 900 mg three times a day

  • Metformin MR 1 g OD

  • Mirtazepine 45 mg OD

  • Isosorbide mononitrate 20 mg twice a day (BD)

  • Aspirin 75 mg OD

  • Ramipril 10 mg OD

  • Solifenacin 5 mg OD

  • Tamsulosin 400 μg OD

ARV exposure:

  • current: Nevirapine/Tenofovir/Raltegravir

Despite good HIV control, this patient has a complex medical background, with polypharmacy, uncontrolled comorbidities and presentations representing frailty syndromes, namely falls, continence issues and both cognitive and functional decline. In the management of complex older adults, the next step is a comprehensive geriatric assessment to investigate potential causes of his symptoms, including the impact of possible psychiatric diagnoses, the aetiology and relevance of drug interactions, and to consider referral to appropriate multidisciplinary team (MDT) members. In this case, the falls were in part due to postural hypotension, prompting discontinuation of …

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