Frailty Linked to Urinary Symptoms in Adults With and Without HIV

Frailty, but not HIV serostatus, was associated with more severe lower urinary tract symptoms (LUTS) in a large cohort of adults with and at risk for HIV, according to a study published in the Journal of the American Geriatrics Society.¹

Why LUTS and Frailty Matter in HIV Care

LUTS are common, increase with age, and can reduce quality of life. Frailty is an aging-related syndrome marked by diminished physiologic reserve, and it has become increasingly relevant as the proportion of older adults living with HIV grows.² People with HIV have an elevated risk of frailty, yet the authors said that, to their knowledge, no prior study had evaluated whether frailty is associated with LUTS in this population or whether the association differs by sex.¹

Investigators analyzed data from the MACS-WIHS Combined Cohort Study, which includes adults with HIV and demographically similar adults without HIV. Participants completed the Lower Urinary Tract Dysfunction Research Network 10-Item Symptom Index (LURN SI-10) between October 2021 and September 2022. Frailty was classified using the Fried frailty phenotype as robust, pre-frail, or frail. After exclusions, the analytic population included 1953 participants. Models were stratified by sex and adjusted for age, race, HIV serostatus, smoking, and depressive symptoms, as well as number of live births among women.

Frailty Tracked With Symptom Severity

Frailty was common. Among women, 53% were pre-frail and 23% were frail, compared with 46% and 13% of men. Women with frailty scored 3.3 points higher on the LURN SI-10 than robust women (95% CI, 2.3-4.3), and men with frailty scored 1.6 points higher than robust men (95% CI, 0.4-2.9). Pre-frailty was not significantly associated with symptom scores in either sex. The association trended stronger in women, although the frailty-by-sex interaction did not reach statistical significance (P = .06).

Frailty was associated with greater odds of urgency urinary incontinence (UUI) and overactive bladder (OAB) in both sexes. Both outcomes were defined by symptoms occurring at least a few times in the past 7 days. Women with frailty had higher odds of UUI (adjusted OR [aOR], 2.57; 95% CI, 1.47-4.50) and OAB (aOR, 1.92; 95% CI, 1.23-3.01) than robust women. Men with frailty had higher odds of UUI (aOR, 3.62; 95% CI, 1.82-7.22) and OAB (aOR, 2.22; 95% CI, 1.10-4.45) than robust men. There was no evidence that the UUI or OAB associations differed by sex. Among women, frailty was also associated with mixed urinary incontinence (aOR, 4.23; 95% CI, 1.92-9.29). It was not analyzed in men because of low prevalence.

HIV Serostatus Not Associated With LUTS

HIV serostatus, undetectable viral load, and CD4+ T-cell count were not associated with LUTS in either sex. "Contrary to our expectation, HIV serostatus was not associated with LUTS," the authors wrote.

Among men, however, HIV status modified the association between frailty and UUI (P for interaction = .01). The association was stronger in men without HIV (aOR, 10.09; 95% CI, 3.46-29.38) than in men with HIV (aOR, 1.34; 95% CI, 0.51-3.50). The authors described these findings as exploratory and noted that, because few men with frailty had UUI, the confidence intervals in the stratified models were wide and overlapping.

Limitations and Next Steps

The cross-sectional design prevents conclusions about causality or directionality. Pandemic-related disruptions to in-person assessments meant frailty components were often unavailable at the LURN SI-10 visit, so data were imputed from surrounding visits. A multiple imputation sensitivity analysis produced materially unchanged results.

The authors said the findings support considering LUTS and frailty screening for midlife adults with and at risk for HIV and that interventions to prevent prefrailty and frailty may reduce LUTS burden. They called for further research into the sex-independent mechanisms that link frailty and LUTS in this population.

References

1. Abelman RA, Ma Y, Margolick JB, et al. Frailty is associated with lower urinary tract symptoms in adults with and without HIV. J Am Geriatr Soc. Published online October 26, 2026. doi:10.1111/jgs.70795
2. Piggott DA, Erlandson KM, Yarasheski KE. Frailty in HIV: epidemiology, biology, measurement, interventions, and research needs. Curr HIV/AIDS Rep. 2016;13(6):340-348. doi:10.1007/s11904-016-0334-8