The Prevalence and Influencing Factors of Frailty Among Middle‐Aged and Older Adults With HIV / AIDS From a Global Perspective: A Systematic Review and Meta‐Analysis

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AIM: Currently, frailty has become a central issue in health management among middle-aged and older people living with HIV/AIDS (PLWHA) worldwide. The objective is to develop targeted strategies to improve frailty in this group, enhance their long-term quality of life, and advance the management of chronic diseases in healthcare settings. METHODS: A comprehensive computer-based search was conducted across 11 databases to identify observational studies that reported the prevalence or influencing factors of frailty among middle-aged and older PLWHA. The search period spanned from the database's inception to August 19, 2025. The meta-analysis of the overall prevalence of frailty and associated factors was performed using Stata 17.0 and RevMan 5.4, respectively. Two independent researchers assessed the risk of bias using the Agency for Healthcare Research and Quality (AHRQ) and the Newcastle-Ottawa scale (NOS). RESULTS: This study screened 43 studies from 2040 publications. The meta-analysis revealed an overall prevalence of frailty among middle-aged and older PLWHA of 12%. Factors significantly associated with frailty in this population included age ≥ 60 years, single, widowed, or divorced, low educational level, history of tobacco use, ≥ 1 comorbidities, diabetes, hepatitis, renal disease, osteoporosis, sleep disorders, neurocognitive impairment, cardiovascular disease, presence of depressive symptoms, and current CD4 cell count < 200 cells/μL. CONCLUSION: Based on the evidence generated by this study, frailty management should be prioritized among PLWHA to support the transition of AIDS from a life-threatening disease to a manageable chronic condition, ultimately achieving the goal of enabling patients to live with quality and dignity.

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