Biopsychosocial Determinants of Frailty in Older People Living With HIV in China: A Bayesian Network Analysis

Abstract – People living with HIV (PWH) experience accelerated aging and elevated frailty risk, representing the convergence of biological and psychosocial aging processes. We enrolled 665 PWH ages ≥50 years in a multicenter study in China. We examined the intersection of biological factors (e.g. CD4⁺ T-cell count, comorbidities), psychological factors (i.e. depression, anxiety), and social determinants in frailty development. A Bayesian network model was developed to characterize these complex interactions. Frailty prevalence was 17.1%. The Bayesian network identified depression as a central node connecting immune dysfunction to frailty through a CD4→anxiety→depression pathway. The model achieved robust performance (area under the curve = 0.879). Probability of frailty ranged from 1.4% in individuals aged 50–59 years without risk factors to 74.0% in those ages ≥70 years with depression and multiple comorbidities. This model offers clinicians a practical risk assessment tool for aging PWH and highlights depression as a modifiable target, supporting the integration of mental health screening in HIV geriatric care.