Poorer Health Linked to Living Longer with HIV Diagnosis

Anxiety and depression linked to longer time living with HIV.

HIV was once considered a death sentence, but with advances in antiretroviral therapy (ART), the landscape has seemingly changed overnight. However, a new study published in HIV Medicine found an association between living longer with HIV and poor quality of life.

Changes in treatment and care have allowed a large proportion of individuals living with HIV to have near-normal or normal life expectancy, according to NAM (previously referred to as the National AIDS Manual). In fact, diseases associated with older age are not a leading cause of serious illness and death among people with HIV.

However, there have been few studies examining the effects of older age on the overall wellbeing of those living with HIV.

For the study, investigators developed a questionnaire to measure the effect of age on the prevalence of symptoms causing distress; symptoms of anxiety and depression; and the prevalence of health-related function problems among individuals receiving care at 9 clinics in the UK. Additionally, the questionnaire asked about the time since HIV diagnosis and demographic factors.

In total, the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study included 3258 individuals, NAM reported.

Among the participants, 69% were men who have sex with men (MSM); 11% were heterosexual men; and 20% were women. The mean age was 45 years and 28% were 50 years or older.

Approximately 685 of participants were white and one-fifth were black African. Forty-five percent of participants had been living with diagnosed HIV for 10 years or longer.

Overall, 86% of individuals were undergoing ART, 76% had an undetectable viral load, and 81% had a CD4 count above 350 cells/mm3. According to NAM, older participants were more likely to be male, white, born in the UK, had been living with diagnosed HIV for at least 10 years, were taking ART, and had an undetectable viral load.

The results of the study showed that 56% of participants reported at least 1 distressing physical symptom, and 11% had 10 or more distressing symptoms. The most common symptoms were lack of energy, difficulty sleeping, feeling tired, aches and pains, and sexual problems.

No trends were observed in the prevalence of physical symptoms with age. Additionally, individuals 60 years or older had the lower prevalence of physical symptoms compared with the other groups.

Interestingly, the investigators found that time since HIV diagnosis was strongly related to the prevalence of symptom distress, with differences among gender/sexual orientation.

There were 27% of participants who reported having depression and 22% anxiety, but the prevalence tended to decrease with age. However, longer time since diagnosis was strongly associated with a higher prevalence of both anxiety and depression.

The investigators also found that the overall prevalence of health-related functional issues was 38%, with 27% reporting mobility issues, 12% problems with self-care, and one-third had problems performing usual activities. The prevalence of function problems significantly increased with age, according to the authors. Additionally, they were strongly associated with longer time since HIV diagnosis.

“With older age, people living with HIV reported a higher prevalence of health-related functional problems, but a lower prevalence of depression and anxiety problems,” the authors wrote. “Longer time with diagnosed HIV infection, however, was related to a higher prevalence of all self-rated health problems: symptoms distress, depression, anxiety, and each domain of functional problems, independent of age.”

The authors hope that the findings will be taken into account in the design of services for the aging HIV-positive population.

“The strong and consistent associations between longer time with diagnosed HIV infection and poorer self-reported health, even after accounting for age, suggest a need for supportive strategies for people who have lived with HIV for a long period of time … and emphasize the importance of regular care and ongoing evaluation of psychological health, even for individuals who are virologically stable on ART,” the authors concluded. “Independent associations of both older age and longer time since HIV diagnosis with physical health problems emphasize the importance of screening and assessment for age-related conditions among people under care for HIV infection, and prompt referral to suitable services.”