Impact of HIV, Age and Comorbidity on Depression and Quality of Life
Having HIV infection independently raised chances of depression and worse health-related quality of life (HRQL) in a 1000-person comparison of older adults with or without HIV. More non-HIV comorbidities independently predicted worse physical HRQL.
Ascertaining the relative impact of aging with versus without HIV is complicated by the lack of a suitable HIV-negative comparison group. Assessing the impact of aging can be particularly difficult when the outcomes are psychological or self-reported. Researchers in the Netherlands tried to meet these challenges by using validated depression and HRQL questionnaires to compare older HIV-positive adults with behaviorally similar HIV-negative people.
In 2010-2012, the Netherlands AGEhIV cohort recruited HIV-positive adults at least 45 years old from an Amsterdam HIV clinic. Matching for age and sex, they recruited HIV-negative people attending an Amsterdam sexual health clinic. Researchers evaluated both groups for age-associated noncommunicable diseases such as hypertension, diabetes and non-AIDS cancer. All participants completed the Medical Outcomes Study Short Form 36 (SF-36) to assess HRQL and the 9-item Patient Health Questionnaire (PHQ-9) to assess depressive symptoms. The researchers used multiple linear regression analysis to assess factors associated with HRQL; they used multiple logistic regression analysis to assess factors associated with depression (PHQ-9 score ≥10).
The study focused on 541 people with HIV and 524 HIV-negative controls. Median age stood at 52.9 years in the HIV group and 52.1 years in the control group (P = .19). Similar proportions with and without HIV were men (89% and 85%, P = .12) and men who have sex with men (74% and 70%, P = .14). HIV-positive people had a lower education level and were less likely to be Dutch. The HIV group had a higher average number of age-associated noncommunicable comorbidities (1.29 versus 0.96, P < .001). Almost everyone (96%) with HIV was taking antiretroviral therapy, and 92% had a viral load below 200 copies/mL.
In unadjusted analyses, the HIV group had a higher prevalence of depression (14.5% versus 8.0%) and significantly worse HRQL scores in eight of the 10 SF-36 scales. HRLQ effect-size differences between people with and without HIV were small to medium in magnitude. However, in the fully adjusted model, the effect size indicating worse depression in the HIV group reached 2.90 (P ≤ .01), indicating a large effect. Differences between people with and without HIV remained significant on six of the 10 SF-36 scales for HRQL and on the PHQ-9 for depression after adjustment for all variables and covariates.
In the multivariate model examining factors related to HRQL and depression, HIV infection was independently associated with worse physical HRQL, worse mental HRQL and a higher likelihood of depression. More comorbidities independently predicted physical HRQL but not mental HRQL or depression. Younger age was independently associated with worse mental HRQL and a greater likelihood of depression but not with physical HRQL.
Not using nucleoside monotherapy or dual therapy was linked to a 2.7-point higher physical HRQL (P = .005), but no other antiretroviral or clinical variables could be tied to mental HRQL or depression.
The researchers stressed that in this comparison of older adults with well-controlled HIV infection and behaviorally similar HIV-negative adults, having HIV independently predicted worse physical and mental HRQL and a higher likelihood of depression.
Linking more comorbidities to worse physical HRQL reinforces the need "to optimize prevention and management of comorbidities as the HIV-infected population continues to age." But the researchers believe their findings "suggest that the negative impact of HIV infection on HRQL will remain even in the presence of optimized prevention and management of comorbidities ... because the negative impact of HIV infection was statistically independent[.]"
Notably, HRQL differences between people with versus without HIV did not become greater with age or with more comorbidities. Indeed, the HRQL difference between the two groups diminished somewhat with age.