Non-AIDS-defining comorbidities impact health related quality of life among older adults living with HIV

Alice Zhabokritsky; Marina Klein; Mona Loutfy; Giovanni Guaraldi; Nisha Andany; Silvia Guillemi; Julian Falutz; Gordon Arbess; Darrell H S Tan; Sharon Walmsley

doi:10.3389/fmed.2024.1380731

Non-AIDS-defining comorbidities impact health related quality of life among older adults living with HIV

Front Med (Lausanne). 2024 Apr 16:11:1380731. doi: 10.3389/fmed.2024.1380731. eCollection 2024.

Authors

Affiliations

¹ Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
² Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada.
³ Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, ON, Canada.
⁴ Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy.
⁵ Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada.
⁶ BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada.
⁷ Unity Health Toronto, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Unity Health Toronto, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract

Introduction: The life expectancy of people living with HIV receiving effective combination antiretroviral therapy is approaching that of the general population and non AIDS-defining age-related comorbidities are becoming of greater concern. In order to support healthy aging of this population, we set out to explore the association between multimorbidity (defined as presence of 2 or more non AIDS-defining comorbidities) and quality of life (QoL).

Methods: We performed a cross-sectional analysis using data from the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV age 65 years and older. Study participants completed two QoL modules, the general QoL and health related QoL (HR-QoL).

Results: 433 participants were included in the analysis with a median age of 69 years (interquartile range, IQR 67-72). The median number of comorbidities among study participants was 3 (IQR 2-4), with 78% meeting the definition of multimorbidity. General QoL scores (median 66, IQR 58-76) were lower than HR-QoL scores (median 71, IQR 61-83) and were not associated with multimorbidity after adjusting for age, sex, relationship status, household income, exercise, tobacco smoking history, malnutrition, time since HIV diagnosis, and HIV-related stigma. In contrast, multimorbidity was associated with lower HR-QoL (adjusted β = -4.57, 95% CI -8.86, -0.28) after accounting for the same variables. Several social vulnerabilities (not having a partner, low household income), health behaviours (lower engagement in exercise, smoking), and HIV-related factors (HIV stigma, longer time since HIV diagnosis) were also associated with lower QoL.

Discussion: Overall, our study demonstrated a high burden of multimorbidity among older adults living with HIV in Canada, which has a negative impact on HR-QoL. Interventions aimed at preventing and managing non-AIDS-defining comorbidities should be assessed in people living with HIV to determine whether this can improve their HR-QoL.

Keywords: HIV; multimorbidity; non-communicable diseases; quality of life; stigma.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study is funded through Canadian Institute for Health Research (CIHR-grant number HAL 157983), and through the Canadian HIV Clinical Trials Network (CTN 314).