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About 400 men with and without HIV, median age 60 years, participating in a sub-study of the MACS (Multicenter AIDS Cohort Study), were evaluated for body composition (waist circumference, abdominal visceral and subcutaneous adipose tissue, sarcopenia, and osteopenia/osteoporosis) and presence of frailty (Fried definition). The frailty frequency was 16% for men with HIV and 8% for men without HIV (2.43 increased odds of frailty). Increased abdominal visceral adipose tissue, greater waist circumference, sarcopenia, and femoral neck osteoporosis were associated with frailty but BMI and subcutaneous adipose tissue were not. This relationship was the same for those with and without HIV. Greater abdominal obesity, sarcopenia, and other measures of body composition are related to frailty and could assist in the diagnosis of frailty and provide a better understanding of the pathophysiology of body composition and frailty.