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Over three decades after the first recognition of HIV related disease, we are in a completely different place. HIV is no longer the harbinger of almost inevitable decline and death, and our patients are getting older. This success story brings with it new challenges for genitourinary medicine and beyond in the UK. Many patients who had a close brush with death at the tipping point, as highly active antiretroviral therapy was rolled out in 1996–1997 are now close to or after retirement, looking forward to years they never expected to have. Frailty is a term that few of today’s senior physicians learnt in their early medical posts. It denotes people at risk of declining health and function, a useful category for …