HIV İle Yaşayan Bireylerin 8 Yıllık İzleminde Kırılganlık Ve Sarkopeni Değişimi: 2018 Hacettepe Kohortunun Yeniden Değerlendirilmesi

Abstract

Gamze SABAN, Changes in Frailty and Sarcopenia Over an 8-Year Follow-Up Among People Living with HIV: A Prospective Reassessment of the 2018 Hacettepe Cohort. Hacettepe University Faculty of Medicine, Thesis in Internal Medicine. Ankara, 2026. Objective: With effective antiretroviral therapy, HIV infection has become a chronic condition, and comorbidity, frailty, sarcopenia, and geriatric syndromes have become increasingly relevant in aging people living with HIV (PLWH). This study aimed to reassess a cohort of PLWH aged ≥40 years evaluated at Hacettepe University in 2018 and to examine 8-year changes in frailty, sarcopenia, comorbidity burden, and geriatric syndromes. Materials and Methods: This was an ambispective longitudinal cohort study. Of 95 PLWH evaluated in 2018, 56 were reassessed face-to-face in 2026, and 4 deaths were recorded. Demographic characteristics, HIV-related parameters, ART history, comorbidities, Charlson Comorbidity Index, VACS-2, D:A, and FRAX scores were evaluated. Frailty was assessed using the Fried phenotype, Edmonton Frail Scale, and Social Frailty Index. Sarcopenia was evaluated according to the EWGSOP2 algorithm using muscle strength, physical performance, and BIA-based muscle mass parameters. Muscle ultrasonography was performed as a supportive morphologic assessment and was not used as an EWGSOP2 diagnostic criterion. Cognitive status, basic and instrumental activities of daily living, nutritional status, depressive symptoms, falls, and urinary incontinence were assessed within a comprehensive geriatric evaluation. Results: Median age increased from 48.5 (45.0–54.8) years in 2018 to 56.0 (52.3–62.8) years in 2026; 76.8% were male. The proportion with current HIV RNA <50 copies/mL was 87.5%. CD4 count increased from 684.5 (469–926) to 901.0 (716.8–1139.3) cells/mm³, and the CD4/CD8 ratio increased from 0.74 (0.60–1.02) to 1.03 (0.82–1.37) (p<0.001). Charlson score increased from 0 (0–1) to 2 (1–3), and D:A cardiovascular risk increased from 15.6% (9.4–27.4) to 32.2% (22.7–49.6) (p<0.001). VACS-2 score decreased from 40.09±9.17 to 33.36±9.49 (p<0.001). Fried frailty decreased from 16.1% to 10.7%, whereas pre-frailty increased from 26.8% to 44.6%; the overall categorical change was not statistically significant. According to the Edmonton Frail Scale, the proportion of non-frail participants increased from 73.2% to 82.1% (p=0.039). Social pre-frailty and social frailty were present in 41.1% and 8.9%, respectively. Sarcopenia stages showed significant progression: the normal category decreased from 85.7% to 69.6%, whereas probable sarcopenia increased from 10.7% to 19.6% and confirmed sarcopenia from 3.6% to 10.7% (p=0.016). In the 2026 cross-sectional EWGSOP2 assessment, 26.8% had probable sarcopenia and 3.6% had confirmed sarcopenia; severe sarcopenia was not observed. BMI increased from 26.61±3.38 to 27.93±4.50 kg/m² (p<0.001). Normal bone mineral status decreased from 78.6% to 46.4%, whereas osteopenia increased from 8.9% to 44.6% and osteoporosis from 0% to 8.9% (p<0.001). Independence in basic and instrumental activities of daily living was 91.1%, normal nutritional status according to MNA-SF was 91.1%, and median MMSE score was 29 (28–30). Falls within the previous year and urinary incontinence were reported in 21.4% and 17.9%, respectively. In exploratory regression analyses, male sex was associated with lower odds of sarcopenia progression, whereas previous protease inhibitor exposure was associated with higher odds. Conclusion: This study provides longitudinal data from Türkiye on 8-year changes in frailty, sarcopenia, comorbidity burden, and comprehensive geriatric assessment in the same PLWH cohort. Despite sustained virologic suppression and immunologic improvement, comorbidity burden, cardiovascular risk, bone mineral disorders, and sarcopenia increased over time. These findings support the integration of muscle and bone health, frailty, physical function, cognition, nutrition, falls, medication burden, and social vulnerability into routine geriatric-oriented HIV care.