Prediction Models for Frailty in People Living With HIV: Protocol for a Systematic Review and Meta-Analysis of Prognostic Models.

BACKGROUND

With the advent of antiretroviral therapy, the life expectancy of people living with HIV has increased significantly, leading to a growing prevalence of frailty and its associated adverse outcomes. However, frailty prediction models developed for the general older population may not apply to people living with HIV due to their distinct immunologic, inflammatory, and comorbidity profiles. To the best of our knowledge, no systematic review to date has comprehensively evaluated frailty prediction models specifically developed for people living with HIV.

OBJECTIVE

This systematic review aims to identify and critically appraise existing prediction models for frailty in people living with HIV, critically appraise their methodological quality, and summarize their predictive performance.

METHODS

Research will be located by searching electronic databases, including PubMed, Web of Science, and other major databases. Two independent reviewers will conduct the screening of titles and abstracts, evaluate full texts, and extract data. The extraction process will adhere to the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS) and the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis Or Diagnosis (TRIPOD) statement. A systematic evaluation of the included studies will be performed to assess their risk of bias and applicability, using the Prediction model Risk Of Bias Assessment Tool (PROBAST). If appropriate, meta-analyses will be used to synthesize quantitative data related to the predictive performance of these models.

RESULTS

This protocol was registered with PROSPERO (CRD420261332573) in June 2025. The systematic literature search was conducted on July 20, 2025, with screening completed in October 2025, identifying five eligible studies; data analysis is scheduled for April 2026, with manuscript submission expected by June 2026.

CONCLUSIONS

This systematic review will provide the first comprehensive synthesis of frailty prediction models for people living with HIV. By identifying robust models and methodological gaps, the findings are expected to inform clinical decision-making and guide future model development and validation efforts in HIV care.