In people with HIV infection, which is a greater contributor to lower quality of life: older age or length of time diagnosed with the disease?
In a study in the February 2017 HIV Medicine, McGowan and colleagues set out to assess the association of age with the prevalence of physical symptoms causing distress, the prevalence of depression and anxiety symptoms, and the prevalence of health-related functional problems. The authors took into account the time since HIV diagnosis and other demographic factors.
They found that a longer time with diagnosed HIV infection, rather than age, contributes to psychological morbidity and lower quality of life.
A closer look
The multicenter, cross-sectional questionnaire study included 3258 HIV-diagnosed adults (2248 men who have sex with men, 373 heterosexual men and 637 women) recruited from United Kingdom clinics in 2011–2012. The researchers assessed associations of age group with physical symptom distress (significant distress for at least one of 26 symptoms), depression and anxiety symptoms, and health-related functional problems (problems on at least one of three domains) adjusting for time with diagnosed HIV infection, gender/sexual orientation, and ethnicity.
The age distribution of participants was 5% < 30 years, 23% 30–39 years, 43% 40–49 years, 22% 50–59 years, and 7% ≥ 60 years.
Prevalence of physical symptom distress was 56%; depression symptoms, 27%; anxiety symptoms, 22%; and functional problems, 38%.
No trend was found in the prevalence of physical symptom distress with age. The prevalence of depression and anxiety symptoms decreased with age, but prevalence of functional problems increased with age.
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.
“Older adults may face fewer high-demand situations as a consequence of retirement, leaving increased time and mental reserves for coping with physical distress. It could also reflect ‘resilience’ in older HIV-diagnosed people, lower expectations of good health, or greater tolerance of poor health function,” noted the authors.
They suggest people who have lived with HIV for a long time need supportive strategies and emphasize the importance of regular care and ongoing evaluation of psychological health—even for those who are virologically stable. They underscore the importance of screening and assessment for age-related conditions among people under care for HIV infection, and prompt referral to suitable services.