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Longer Time With HIV -- Not Age -- Tied to Symptom Distress, Depression, Anxiety

January 27, 2017

Longer time with HIV infection -- but not older age -- predicted a higher prevalence of self-reported symptom distress, depression and anxiety in a United Kingdom (UK) analysis of 3258 adults with HIV infection. Depression and anxiety became less frequent with age.

As survival with HIV infection increases, HIV populations in many regions are aging. In the United Kingdom, more than one-quarter of people with HIV were 50 years old or older in 2013. Physical and psychological problems may change in an aging population. But little is known about how older age and, separately, longer time with HIV infection affect standard measures of physical and psychological health.

To address those questions, researchers working with the UK ASTRA cohort conducted this cross-sectional analysis. In 2011-2012 ASTRA recruited 3258 HIV-positive adults from eight outpatient clinics across the UK. Participants completed a questionnaire on sociodemographic factors and health issues. ASTRA members also completed a modified Memorial Symptom Assessment Scale-Short Form (MSAS-SF) ranking distress for 26 common symptoms on a 4-point scale. The researchers defined "physical symptom distress" as reporting at least one of the 26 symptoms as distressing. They rated depression on the Patient Health Questionnaire 9-item scale (PHQ-9) and anxiety on the Generalized Anxiety Disorder 7-item scale (GAD-7). A total score of 10 or more indicated depression or anxiety. A "health-related functional problem" meant reporting "some" or "severe" problems on the Euroqol 5D 3L (EQ-5D-3L).

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The researchers used logistic regression adjusted for gender/sexual orientation, ethnicity and years with HIV to explore associations between age group and each of the four health measures. They performed tests for linear trends across categories for age and years with diagnosed HIV infection.

Of the 3258 study participants, 69% were men who have sex with men (MSM), 11.4% heterosexual men and 19.6% women. Age averaged 45 years (range 18 to 88). The largest proportion of participants (42.9%) ranged from 40 to 49 years in age, 21.6% were 50 to 59 and 6.7% were 60 or older. While 27.6% of participants had diagnosed HIV infection for five to ten years, 20% had HIV for 10 to 15 years, 15.1% for 15 to 20 years and 10.2% for 20 or more years. Two-thirds of participants were white.

Physical symptom distress did not change with age. Depression prevalence fell with age (in test for trend across age brackets adjusted odds ratio [aOR] 0.86, 95% confidence interval 0.79 to 0.94, P = .001), as did anxiety prevalence (aOR 0.85, 95% CI 0.77 to 0.94, P = .001). Odds of functional problems rose with age (aOR 1.28, 95% CI 1.17 to 1.39, P < .001).

Longer time with diagnosed HIV infection raised odds of all four outcomes: physical symptom distress (in test for trend across age brackets aOR 1.21, 95% CI 1.14 to 1.27, P < .001), depression (aOR 1.20, 95% CI 1.13 to 1.27, P < .001), anxiety (aOR 1.21, 95% CI 1.13 to 1.29, P < .001) and functional problems (aOR 1.36, 95% CI 1.29 to 1.44, P < .001).

Compared with MSM, heterosexual men experienced less physical symptom distress (aOR 0.75, 95% CI 0.58 to 0.97, P = .047). But ethnicity (white versus other) did not independently affect symptom distress. Neither gender/sexual orientation nor ethnicity independently affected any of the other three outcomes.

The authors stress that their findings "do not support the hypothesis that older ... people living with HIV have a disproportionate burden of symptoms." But people with longer diagnosed HIV infection did have a higher symptom burden, plus more depression, anxiety and functional problems. Because psychological health appeared to be better in older people with HIV, the investigators call for "further exploration of 'successful aging' ... and the positive effects of age on coping."

Mark Mascolini writes about HIV infection.


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