Age, time living with diagnosed HIV infection, and self‐rated health

Abstract

ObjectivesAn increasing proportion of people living with HIV are older adults, who may require specialized care. Adverse physical and psychological effects of HIV infection may be greatest among older people or those who have lived longer with HIV.MethodsThe ASTRA study is a cross‐sectional questionnaire study of 3258 HIV‐diagnosed adults (2248 men who have sex with men, 373 heterosexual men and 637 women) recruited from UK clinics in 2011–2012. Associations of age group with physical symptom distress (significant distress for at least one of 26 symptoms), depression and anxiety symptoms (scores ≥ 10 on PHQ‐9 and GAD‐7, respectively), and health‐related functional problems (problems on at least one of three domains of the Euroqol 5D‐3L)) were assessed, adjusting for time with diagnosed HIV infection, gender/sexual orientation and ethnicity.ResultsThe age distribution of participants was: < 30 years, 5%; 30–39 years, 23%; 40–49 years, 43%; 50–59 years, 22%; and ≥ 60 years, 7%. Overall prevalences were: physical symptom distress, 56%; depression symptoms, 27%; anxiety symptoms, 22%; functional problems, 38%. No trend was found in the prevalence of physical symptom distress with age [adjusted odds ratio (OR) for trend across age groups, 0.96; 95% confidence interval (CI) 0.89, 1.04; P = 0.36]. The prevalence of depression and anxiety symptoms decreased with age [adjusted OR 0.86 (95% CI 0.79, 0.94; P = 0.001) and adjusted OR 0.85 (95% CI 0.77, 0.94; P = 0.001), respectively], while that of functional problems increased (adjusted OR 1.28; 95% CI 1.17, 1.39; P < 0.001). In contrast, a longer time with diagnosed HIV infection was strongly and independently associated with a higher prevalence of symptom distress, depression symptoms, anxiety symptoms, and functional problems (P < 0.001 for trends, adjusted analysis).ConclusionsAmong people living with HIV, although health‐related functional problems were more common with older age, physical symptom distress was not, and mental health was more favourable. These results suggest that a longer time with diagnosed HIV infection, rather than age, is the dominating factor contributing to psychological morbidity and lower quality of life.

Risky Alcohol Consumption and Associated Health Behaviour Among HIV-Positive and HIV-Negative Patients in a UK Sexual Health and HIV Clinic: A Cross-Sectional Questionnaire Study

“…Eleven percent of HIV-positive patients reported moderate or severe depressive symptoms when measured using the PHQ-9 questionnaire. Previous studies utilising the PHQ-9 questionnaire have reported higher prevalences of depression among HIV-positive patients compared to our study, ranging from 14.5 to 27% [29][30][31]. Sociodemographic characteristics of our patients may in part explain the disparities in findings.…”

“…Sociodemographic characteristics of our patients may in part explain the disparities in findings. Increased depressive symptoms among HIV-positive patients have been associated with female gender, low socioeconomic status and younger age [30,31], whereas majority of our patients were men, in full-time employment or students and had a mean age of 46 years. However, the association between moderate or severe depressive symptoms and risky alcohol consumption found in this study highlights the importance to screen for lower levels of alcohol consumption among HIV-positive patients, as the majority of our patients who reported risky alcohol consumption were consuming on hazardous levels.…”

Implications for a policy of initiating antiretroviral therapy in people diagnosed with human immunodeficiency virus: the CAPRA research programme

“…The prevalence of physical functional problems among people infected with HIV increased with older age, but the prevalence of symptom distress did not, and the prevalence of depression and anxiety decreased with older age. In contrast to this, the length of time diagnosed with a HIV infection was strongly and positively correlated with the prevalence of all adverse health and symptom measures, and this was independent of age (see McGowan et al 35 ). This marked association of the longer time since HIV diagnosis with poor self-rated health is likely, in part, to be related to an earlier calendar year of diagnosis, representing an effect of diagnosis in the pre-ART and early-ART eras, but may also be as a result, specifically, of the longer time diagnosed with a HIV infection and, as such, may represent an important effect related to ageing with a HIV infection.…”

Prevalence and correlates of psychological distress of middle-aged and older women living with HIV

“…Despite HIV and age-related consequences, there is evidence showing that older adults seem to demonstrate strengths and even decreased symptoms of depression and anxiety when compared to younger adults (McGowan et al, 2016). In our study, gender seems to play a more salient role in the prevalence of psychological distress.…”