Canadian study explores the impact of aging on people with HIV

• A study analyzed the health-related quality of life of 433 older Canadians living with HIV
• Participants had on average three comorbidities, such as high cholesterol and high blood pressure
• Despite high rates of comorbidities, 86% reported qualify of life satisfaction

Thanks to HIV treatment (antiretroviral therapy, ART), many people with HIV are living well into their senior years. As people with HIV age, research is needed to help them stay healthy and minimize or avoid aging-related complications.

Although when used as directed ART is highly effective at suppressing HIV and maintaining a healthy immune system, subtle issues within the immune system persist. These issues— such as ongoing activation of the immune system and excess levels of inflammation—likely contribute to a higher risk for conditions such as heart disease, bone thinning, decreasing kidney function, diabetes and other comorbidities.

A team of researchers in Canada recruited older people with HIV for a study on aging called Correlates of Healthy Aging in Geriatric HIV (Change HIV). The study is accumulating data and beginning to perform analyses of this data. A recent publication from the study focused on health-related quality of life and comorbidities. The researchers found a high level of comorbidities (on average, three) among participants; this is called multimorbidity and it was associated with lower health-related quality of life. Social vulnerabilities, such as not having a partner, low household income, smoking and lower engagement in exercise, were also linked to reduced quality of life.

The researchers encourage clinicians to intervene with their aging patients in order to prevent and manage comorbidities. Such interventions could be assessed in future studies to determine which are most effective.

Study details

Researchers analyzed data from 433 people whose average age when they entered the study was nearly 70. There were 92% males and 8% females. All participants were taking ART and more than 99% had a suppressed viral load. The average CD4+ count was nearly 560 cells/mm³.

Results

Researchers found that most participants (65%) did not have a partner and many were living alone.

The most common comorbidities reported by the researchers were as follows:

• high levels of cholesterol – 51%
• high blood pressure – 44%
• history of cancer – 29%
• diabetes – 24%
• arthritis – 22%
• painful nerves in the hands and feet (peripheral neuropathy) – 18%
• coronary artery disease – 17%
• depression – 15%
• thin bones – 15%
• chronic liver disease – 14%

Nearly 80% of participants had several comorbidities.

The researchers found that 60% of participants were either malnourished or at risk of malnourishment, but they did not comment further on this.

According to the researchers, despite these findings, a large proportion of participants (86%) reported that they were moderately to very satisfied with their lives. The researchers did not further assess participants about this, but they theorized that the comorbidities were either well managed or perhaps participants had developed “effective coping strategies” and therefore the comorbidities did not have as big an impact on quality of life. The researchers argued that based on their findings, interventions to prevent and manage multiple comorbidities may prove more useful than interventions that aim to improve “general quality of life.”

Stigma and discrimination

The researchers found that negative behaviours toward people with HIV from society was reported by participants. The researchers stated that stigma and discrimination against HIV can compound other forms of bad behaviours, such as stigma and discrimination affecting ethnicity/race, sexual orientation, gender identity, age, disability and poverty. All of these bad behaviours can reduce the quality of life of people with HIV.

The researchers encourage ongoing efforts to “develop and implement effective stigma reduction interventions,” which they see as crucial to improving quality of life among people with HIV.

Long-term survivors

The researchers found a statistical association between longer time since HIV diagnosis and reduced quality of life. They think that this association arises because many long-term survivors were diagnosed in the era when effective ART was not available. As a result, they endured suboptimal and often toxic therapies and severe side effects. What’s more, they likely experienced traumatizing life events, from life-threatening infections to the loss of friends and loved ones. The researchers noted that some long-term survivors did not have partners and that living alone probably degraded their quality of life.

Bear in mind

The researchers analyzed data collected at one or two points in time. However, in the years ahead they should have much more data and will be able to produce other analyses. The present study should be seen as a good first step in studying aging in Canadians with HIV. As more people with HIV live longer thanks to ART, aging-related research needs to continue to be funded.

Interventions needed

Since nearly 80% of participants had a high burden of comorbidities, which can reduce quality of life, the researchers called for studies to assess interventions designed to reduce the risk for developing comorbidities or to better manage them.

In addition, the researchers called for the following issues to be addressed, as they also affect quality of life:

• HIV-related stigma
• smoking cessation (60% of participants either smoked or had a history of smoking)
• participation in exercise programs

The researchers noted that additional interventions may be needed for long-term survivors and people who do not have a partner, “as these individuals tend to experience a lower quality of life even when accounting for comorbidity burden.”

—Sean R. Hosein

Resource

HIV and aging - CATIE

REFERENCES:

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3. Lopez Angel CJ, Pham EA, Du H, et al. Signatures of immune dysfunction in HIV and HCV infection share features with chronic inflammation in aging and persist after viral reduction or elimination. Proceedings of the National Academy of Sciences USA. 2021 Apr 6;118(14):e2022928118. 
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