FRAILTY PREVALENCE, ONE-YEAR RISK, AND THE EFFECT OF SMOKING AMONG WOMEN WITH AND WITHOUT HIV INFECTION

The gap in life expectancy between people with HIV and the general population is diminishing. However, evidence suggests that people with HIV may be experiencing aging-related conditions at earlier ages. The objective of this dissertation was to estimate the prevalence of frailty, a syndrome of physical vulnerability, estimate the one-year risk of frailty, and examine the effect of smoking on the one-year risk of frailty among women with and at risk for HIV. This project used data from the Women’s Interagency HIV Study between October 2015 and September 2017. The Fried Frailty Index was used to define frail status as exceeding the threshold for at least three of five frailty components: slowness, weakness, unintentional weight loss, exhaustion, and low physical activity. Among 1,404 women with a median age of 52 years (interquartile range: 47-57), we found that frailty prevalence was 11.5% (15.3% HIV-, 10.1% HIV+). The most common frailty components were low physical activity and exhaustion. The one-year risk of frailty was 6.6% (95% confidence interval: 4.1, 9.1) and similar for women with and without HIV. After adjustment for confounding, current smokers were 1.68 times as likely to become frail compared to non-smokers (95% CI: 0.69, 4.06). Women with high cumulative smoking exposure were 2.72 times as likely to become frail compared to women with low cumulative smoking exposure (95% CI: 0.96, 7.67), and this latter effect appeared to be more pronounced among women with HIV (adjusted RR = 4.10; 95% CI: 1.22, 13.78). In a low income, predominately black population of women in their mid-fifties with and without HIV infection, the prevalence and risk of frailty is comparable to women in the general population at least 65 years old. Reported smoking exposure is independently associated with increased frailty risk in this population, even over a one-year period of follow-up. These findings demonstrate that modifiable risk factors, such as smoking, could play a crucial role in preventing frailty, especially among people with HIV. Future studies are needed to investigate trends in frailty risk over time and to examine the long-term impacts of smoking on frailty among people with HIV.Doctor of Philosoph