LAUSR

In this issue of Atherosclerosis, Korada et al. [1] report on the association of frailty and subclinical coronary atherosclerosis in 602 HIV þ men, participating in the Multicenter AIDS Cohort study, and 374 un-infected controls. The surprising finding was that sub-clinical atherosclerosis and frailty showed an association in un-infected individuals but not in HIV þ men. These findings and the topic of frailty in HIV þ patients deserve a few observations. HIV þ patients surviving long-term are no longer exceptional, and are a growing demographic phenomenon both in wealthy and in resource limited countries [2]. These individuals comprise a unique population at risk for illnesses and syndromes traditionally associated with the elderly. Among these conditions, cardiovascular disease is projected to become the leading cause of morbidity and mortality in years to come [3]. The implication is that the medical providers for HIV þ patients will need to be aware of geriatric issues and will interact with geriatric medicine specialists in a growing number of cases [4], and will need to learn the same nomenclature, principles and share the same tools. Frail patients bring gerontology within the spectrum of other medical disciplines like cardiology [5], and infectious diseases [6], hence outside the constraints of the geriatrics and gerontology world. The frailty syndrome is characterized by reduction of an individual's homeostatic reserves leading to an increased vulnerability to endogenous and exogenous stressors [7]. It is a condition that affects physical, cognitive, and psychological functions [8], but there remains controversy as to how best define and manage frailty both in the clinical and the research setting [9]. Clinically, frailty could be thought of as a state of reduced physical strength and endurance and/or reduced cognitive function. Often, however, the debate over the definition of frailty and the best tools to measure it detracted from the condition of interest, focusing the debate on the tools rather than the condition [10]. Fried et al. described a phenotype (frailty phenotype: FP) that encompasses the most frequent characteristics of frailty [11]. Rockwood et al. [12] described a cumulative deficit encountered in multiple systems associated with comorbidities and disabilities. To measure this complex condition, investigators proposed using a