Frailty Characteristics in Chronic HIV Patients are Markers of White Matter Atrophy Independently of Age and Depressive Symptoms: A Pilot Study

Kalpana J. Kallianpur1, *, Marissa Sakoda1, Louie Mar A. Gangcuangco2, Lishomwa C. Ndhlovu3, Tracie Umaki1, Dominic Chow1, Suwarat Wongjittraporn4, Cecilia M. Shikuma1
1 Department of Medicine, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
2 Department of Internal Medicine, Bridgeport Hospital-Yale New Haven Health, Bridgeport, CT, USA
3 Department of Tropical Medicine, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
4 Tuomey Healthcare System, Sumter, SC, USA

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 4048
Abstract HTML Views: 1847
PDF Downloads: 606
ePub Downloads: 452
Total Views/Downloads: 6953
Unique Statistics:

Full-Text HTML Views: 1940
Abstract HTML Views: 1073
PDF Downloads: 454
ePub Downloads: 329
Total Views/Downloads: 3796

Creative Commons License
© Kallianpur et al.; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

Correspondence: Address correspondence to this author at the Department of Medicine, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA; Tel: 808-692-1331; Fax: 808-692-1345; E-mail:



Chronic HIV disease is associated with neurocognitive impairment and age-related conditions such as frailty.


To determine whether regional brain volumetric changes correlate with frailty parameters in older (≥ 40 years) HIV+ patients on stable combination antiretroviral therapy.


Thirty-five HIV-infected participants in the Hawaii Aging with HIV Cohort - Cardiovascular Disease study underwent T1-weighted brain magnetic resonance imaging, frailty assessment and neuropsychological testing. Five physical frailty traits were assessed: low physical activity; exhaustion; unintentional weight loss; weak hand grip strength; slow walking speed. Linear regression quantified cross-sectional relationships of 12 brain regions to walking times and hand grip strength.


Participants were 50.6 ± 6.8 years old and 77% had undetectable plasma viral load. One subject was frail (possessing ≥ 3 frailty traits); 23% were pre-frail (1–2 frailty traits) and had worse composite learning and memory z-scores than did non-frail individuals (p=0.06). Pre-frail or frail subjects had reduced hand grip strength relative to the non-frail group (p=0.001). Longer walking times (slower gait) related independently to lower volumes of cerebellar white matter (p<0.001, β=−0.6) and subcortical gray matter (p<0.05, β=−0.30). Reduced thalamus volume was linked to weaker grip strength (p < 0.05, β=0.4). Caudate volume was negatively associated with grip strength (p<0.01, β=−0.5).


Volumetric changes in cerebellar white matter and subcortical gray matter, brain regions involved in motor control and cognition, may be connected to frailty development in well-controlled HIV. Gait speed is particularly sensitive to white matter alterations and should be investigated as a predictor of frailty and brain atrophy in chronically infected patients.

Keywords: Caudate, Cerebellum, Gait speed, Hand grip strength, HIV-associated neurocognitive disorder, Thalamus.