Successful Aging and the Epidemiology of HIV

By 2015, it is estimated that nearly half of those living with HIV in the US will be 50 years of age and older. This dramatic change in the demographics of this clinical population represents unique challenges for patients, health care providers, and society-at-large. Fortunately, because of highly active antiretroviral therapy (HAART) and healthy lifestyle choices, it is now possible for many infected with HIV to age successfully with this disease; however, this depends upon one’s definition of successful aging. It is proposed that successful aging is composed of eight factors: length of life, biological health, cognitive efficiency, mental health, social competence, productivity, personal control, and life satisfaction. Unfortunately, HIV and medication side effects can compromise these factors, thus diminishing one’s capacity to age successfully with this disease. This article explores how HIV, medication side effects from HAART, and lifestyle choices can compromise the factors necessary to age successfully. Implications for practice and research are posited

Driving Habits, Cognition, and Health-Related Quality of Life in Middle-Aged and Older Adults with HIV

Cognitive impairment is known to increase with aging in people living with HIV (PLWH). Impairment in cognitive domains required for safe driving may put PLWH at risk for poor driving outcomes, decreased mobility, and health-related quality of life (HRQoL). This study described the driving behaviors of middle-aged and older PLWH and examined correlations between driving behaviors and cognitive functioning (Aim 1), and driving behaviors and HRQoL domains (Aim 2). A sample of 260 PLWH ages 40 and older completed a comprehensive assessment including a battery of cognitive tests, an HRQoL measure, and a measure of self-reported driving habits. Associations between driving habits, cognitive function, and HRQoL domains were examined. While 212 (81.54%) participants reported currently driving, only 166 (63.85%) possessed a driver\u27s license. Several significant correlations emerged between driving habits and both cognitive and HRQoL variables, with a general pattern suggesting that current greater driving exposure was associated with better cognitive functioning and HRQoL. Given consistent associations that emerged between the social functioning HRQoL domain and several driving habits, multivariable regression was conducted to examine the unique association between an index of greater driving exposure (i.e., days driven per week) and social functioning, adjusting for potential confounders (race, income, education, depression, and global cognition). Results showed that more days driven per week was a significant, independent correlate of higher social functioning. Understanding the factors underlying driving behaviors in PLWH may contribute to interventions to promote better mobility and improved access to care

Physical exercise is associated with less neurocognitive impairment among HIV-infected adults

Abstract Neurocognitive impairment (NCI) remains prevalent in HIV infection. Randomized trials have shown that physical exercise improves NCI in non-HIV-infected adults, but data on HIV-infected populations are limited. Communitydwelling HIV-infected participants (n=335) completed a comprehensive neurocognitive battery that was utilized to define both global and domain-specific NCI. Participants were divided into "exercise" (n=83) and "no exercise" (n=252) groups based on whether they self-reported engaging in any activity that increased heart rate in the last 72 h or not. We also measured and evaluated a series of potential confounding factors, including demographics, HIV disease characteristics, substance use and psychiatric comorbidities, and physical functioning. Lower rates of global NCI were observed among the exercise group (15.7 %) as compared to those in the no exercise group (31.0 %; p<0.01). A multivariable logistic regression controlling for potential confounds (i.e., education, AIDS status, current CD4+ lymphocyte count, self-reported physical function, current depression) showed that being in the exercise group remained significantly associated with lower global NCI (odds ratio=2.63, p<0.05). Similar models of domain-specific NCI showed that exercise was associated with reduced impairment in working memory (p<0.05) and speed of information processing (p<0.05). The present findings suggest that HIVinfected adults who exercise are approximately half as likely to show NCI as compared to those who do not. Future longitudinal studies might be best suited to address causality, and intervention trials in HIV-infected individuals will determine whether exercise can prevent or ameliorate NCI in this population

Older HIV+ and HIV- Adults Provide Similar Definitions of Successful Aging: A Mixed-Methods Examination.

Background and objectiveAs HIV-infected (HIV+) individuals age, there is a need to understand successful aging (SA) from the patient perspective. This study compared SA definitions between HIV+ and HIV-uninfected (HIV-) older adults and then examined correlates of SA categories.Research design and methodsNinety-three HIV+ and 46 HIV- older (aged 50+) adults provided brief definitions of SA, which was examined using content analysis. We then compared the frequency of SA categories by serostatus and examined the correlates of SA categories within both groups.ResultsSeven SA categories emerged: General Health, Cognitive Health & Ability, Physical/Biological Health & Ability, Social Relationships, Attitudes, Psychological, & Emotional Well-Being, Proactive & Engaged Lifestyle, and Independence. While no significant differences emerged, HIV- older adults were more likely to report General Health and the subcategory of Longevity/Survival, while HIV+ older adults were more likely to report subcategories of Enjoying Life & Fulfillment and Maintaining Balance. Few demographic correlates of SA categories emerged. Mood and HIV characteristics were not associated with SA categories. In both groups, those without neurocognitive impairment were significantly more likely to endorse General Health than those with neurocognitive impairment.Discussion and implicationsHIV+ and HIV- older individuals may generally perceive SA similarly, and their definitions parallel with existing models of SA. Yet, living with a chronic illness may cause HIV+ older adults to place greater value on quality of life and life satisfaction than physical health and chronological age. Observational and intervention studies may use similar approaches in evaluating and maximizing SA

Social support and moment-to-moment changes in treatment self-efficacy in men living with HIV: Psychosocial moderators and clinical outcomes.

OBJECTIVE: For people living with HIV, treatment adherence self-efficacy is an important predictor of treatment adherence and therefore of clinical outcomes. Using experience sampling method (ESM), this study aimed to examine: (1) the within-person association between moment-to-moment changes in social support and HIV treatment self-efficacy; (2) the moderators of this within-person association, (3) the concordance between questionnaire and ESM measurement of treatment self-efficacy; and (4) the utility of each approach (ESM and questionnaire) in predicting adherence to medication, adherence to clinic visits, CD4 counts, and viral load. METHODS: 109 men living with HIV responded to the same set of ESM questions 3 times a day for 7 days via a smart phone given to them for the study. They also completed cross-sectional questionnaires and their clinic data was extracted from medical records in order to examine predictors and consequences of state and trait treatment self-efficacy. RESULTS: In within-person hierarchical linear modeling (HLM) analyses, receipt of recent social support predicted higher current ESM treatment self-efficacy. This association was stronger for individuals reporting higher avoidance coping with HIV. The correlation between ESM and questionnaire measures of treatment self-efficacy was r = .37. ESM measure of average treatment self-efficacy predicted medication adherence, visit adherence, CD4 counts, and viral load, while questionnaire-based self-efficacy did not predict these outcomes. CONCLUSION: Interventions aimed at improving treatment adherence may target social support processes, which may improve treatment self-efficacy and adherence