TY - JOUR T1 - How to assess and manage frailty in patients with HIV JF - Sexually Transmitted Infections JO - Sex Transm Infect SP - 476 LP - 477 DO - 10.1136/sextrans-2016-052663 VL - 93 IS - 7 AU - T Levett AU - J Wright Y1 - 2017/11/01 UR - http://sti.bmj.com/content/93/7/476.abstract N2 - 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 yearsinitial CD4 count, 45 cells/mm3 late presentation with Pneumocystis jiroveci pneumonia, defining AIDSstarted antiretroviral drugs (ARVs), 1995current CD4, 556 cells/mm3, viral load undetectable Past medical history: ischaemic heart diseasetype 2 diabetes mellitushypertensionperipheral neuropathydepressionbenign prostatic hypertrophy and bladder instability Drug history: Diltiazem 180 mg once a day (OD)Bendroflumethiazide 2.5 mg ODGabapentin 900 mg three times a dayMetformin MR 1 g ODMirtazepine 45 mg ODIsosorbide mononitrate 20 mg twice a day (BD)Aspirin 75 mg ODRamipril 10 mg ODSolifenacin 5 mg ODTamsulosin 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 … ER -