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HIV Related Distressing Symptoms for Young & Aging HIV+
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Distressing Symptoms (30% see table 1) of Living with HIV at Any Age & Aging with HIV [those 50-60 rates of distressing symptoms increase and in those >60 functioning impairment increases while other symptoms……] of note to me - Jules - this report highlights just how much living with HIV is associated with lots of symptoms regardless of age: in Figure 1 for example 30-60% report sleep/energy/tiredness problems & physical symptom distress, 20-25% report regardless of age concentration/memory problems but of note they report in figure 1 this symptom decreases when person ages >60, BALONEY, aging in over 60 whether one has HIV or not memory in general declines, cognitive difficulties increase ! Instead of spending $$ doing more studies like this we need programs that provide support services for aging HIV+ & services for their clinicians to aid them in assisting their patients, in the UK & the USA. In the USA the NIH & the OAR support a lot of research funding looking for drugs like anti-inflammatories that they hope will curb the devastating & debilitating affects of HIV+ aging with multiple comorbidities & the associated polypharmacy, but whether this research will to will not yield a drug that does this and I have my doubts about the direction & efficacy of the research - we need a dedicated National Discussion on Aging to device a program dedicated to support that address the vast complex array of problems &that directly address the daily living needs of HIV+ and their care clinicians & service providers!
Age, time living with diagnosed HIV infection, and self-rated health
from Jules: this study is a report of self-administered questionnaires by patients in the UK, it reports a high prevalence of "distressing symptoms" in HIV+ regardless of age - 30% at age <30 to 49 experience high degree of distressing life symptoms [see table 1] - but concerningly of note they go on to say that certain distressing symptoms are less in >60 vs 50-59 year olds but similar in <30 to 30-39 year olds, and that depression & anxiety are less prevalent among older, >60 HIV+ compared to all age groups. see Figure 1. Then they sum up by saying the HIV+ over 60 had less of certain symptoms than younger 5-60, and there was no trend towards overall symptoms in older >60 with exceptions length of time with HIV is associated with increased symptoms in general (see Table 2). They go on in the Discussion below to say that those >60 perhaps adjust & get used to some of these symptoms. They find depression & anxiety decrease with age BALONEY, these increase with age! They call less depression & anxiety "successful aging" BALONEY. It is not even relevant to their findings or overall that they find >60 persons have reduced depression & anxiety & certain other symptoms, as they also find functional problems go up quite a lot for those over 60 compared to all younger groups. Finally of note I refer you to the to me more reliable findings of the SF SCOPE Study "Geriatric Syndromes in Older HIV-Infected Adults" where average age was 57 & 40% had depression, 45% cognitive impairment, pre-frailty in 56% (9% frailty), on average patients had 4 comorbidities & were taking 6-12 non-antiretroviral medications, and 56% were having difficulties in performing independent living activities.
this study looked at: a cross-sectional questionnaire study of 3258 HIV-diagnosed adults (2248 men who have sex with men, 373 heterosexual men and 637 women) recruited from UK clinics in 2011-2012. Associations of age group with physical symptom distress (significant distress for at least one of 26 symptoms), depression and anxiety symptoms (scores ≥ 10 on PHQ-9 and GAD-7, respectively), and health-related functional problems (problems on at least one of three domains of the Euroqol 5D-3L)) were assessed, adjusting for time with diagnosed HIV infection, gender/sexual orientation and ethnicity.
Of note: The mean age was 45 years [standard deviation (SD) 9.6 years; range 18-88 years). Of 3190 participants with age information, 172 (5.4%) were under 30 years old, 745 (23.4%) 30-39 years old, 1370 (42.9%) 40-49 years old, 689 (21.6%) 50-59 years old and 214 (6.7%) ≥ 60 years old. Time since diagnosis of HIV infection (n = 3230) was: 0-2 years for 373 patients (11.5%), 2-5 years for 498 (15.4%), 5-10 years for 893 (27.6%), 10-15 years for 647 (20.0%), 15-20 years for 488 (15.1%) and ≥ 20 years for 331 (10.2%).
Symptom distress was defined as: Participants were asked to report whether each symptom was present in the past 2 weeks, and, if so, to rank their distress on a four-point scale: 'did not bother me'; 'bothered/distressed a little bit'; 'bothered/distressed quite a bit'; 'bothered/distressed very much' (see Table 1)
Health-related functional problems were defined as: A 'health-related functional problem' was defined as reporting 'some' or 'severe' problems (rather than 'no problems') on one of three functional domains (mobility, self-care and daily activities) of a standard health-related quality of life (HrQoL) measure, the Euroqol 5D 3L (EQ-5D-3L)
Table 1 reports the prevalence of each symptom according to whether it was (i) present and (ii) distressing. At least one symptom was reported as 'distressing' by 55.6% of participants (1811 of 3258), while 11.0% reported ten or more distressing symptoms. The five most prevalent distressing symptoms were 'lack of energy' (25.9%), 'difficulty sleeping' (24.4%), 'feeling drowsy/tired' (24.2%), 'muscle aches or joint pains' (20.8%) and 'problems with sexual interest/activity' (19.2%). Although lower in prevalence, 'pain' and 'changes in fat' were more likely to cause distress when present than other symptoms.


Figure 1. Prevalences (%) of (a) distressing physical symptoms, (b) depression and anxiety symptoms, and (c) health-related functional problems by age group. Physical symptom distress was defined using modified MSAS-SF (see Table 1); depression symptoms were defined as a PHQ-9 score ≥ 10; anxiety symptoms were defined as a GAD-7 score ≥ 10; health-related functional problems were defined using the three domains of Euroqol 5D 3. N = 3190 participants with information on age..


Age, time living with diagnosed HIV infection, and self-rated health
Hiv Medicine Jan 2017
JA McGowan,1 LSherr,1 AJ Rodger,1 MFisher,2† AMiners, 3 JAnderson,4 MA Johnson,5 JElford, 6 SCollins, 7GHart,1 AN Phillips, 1 A Speakman1 and FC Lampe1 for the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) Study Group*1 Research Department of Infection and Population Health, University College London, London, UK,2 Brighton and SussexUniversity Hospitals NHS Trust, Brighton, UK,3 London School of Hygiene and Tropical Medicine, London, UK,4 Homerton University Hospital NHS Foundation Trust, London, UK,5 Royal Free London NHS Foundation Trust, London, UK, 6 School of Health Sciences, City University, London, UK and7 HIV i-Base, London, UK
In this large multicentre cross-sectional UK study, with older age, people living with HIV reported a higher prevalence of health-related functional problems, but a lower prevalence of depression and anxiety symptoms. There was no trend with age in the prevalence of overall physical symptom distress, but the pattern varied according to the specific symptom. Longer time with diagnosed HIV infection, however, was related to a higher prevalence of all self-rated health problems: symptom distress, depression, anxiety and each domain of functional problems, independently of age.
In our study, as found in the international START (Strategic Timing of AntiRetroviral Treatment) trial population at baseline, [25], the prevalence of problems with physical mobility and daily function (assessed using the EQ-5D-3L) increased with age, probably as a result primarily of an increasing prevalence of chronic illness and disability. Age was not significantly associatied with overall physical symptom distress, but prevalence did increase with age for specific symptom groups (muscle ache/joint pain, and numbness/tingling/pain in hands or feet). However, we found a lower prevalence of distressing symptoms in the over-60s group compared with younger age groups, both overall and for many symptom subgroups. This could, in part, be attributable to older adults attributing health changes to natural ageing and therefore not rating them as distressing [26, 27]. Previous research also posits that older adults may face fewer high-demand situations as a consequence of retirement, leaving increased time and mental reserves for coping with physical distress [28]. It could also reflect 'resilience' in older HIV-diagnosed people, lower expectations of good health, or greater tolerance of poor health function [29].
In terms of mental health, the prevalence of depression and anxiety, assessed using standardized symptom questionnaires, tended to decrease with age,
a trend that became more marked after adjustment for time with diagnosed HIV infection. In particular, the prevalences of depression and anxiety were lower in the over-60s compared with all other age groups. Interestingly, when analysed by individual questions, the decreasing prevalence with age was more apparent for 'psychological' symptoms of depression such as 'feeling down' or 'thoughts you would be better off dead', than for 'physical' symptoms of depression, such as 'feeling tired' or 'appetite problems' (data on request). It is possible that deteriorating physical health in older age, or ageing with HIV infection, in addition to depression contributes to these 'physical' symptoms [30], or that in older adults depression is defined more often by somatic, rather than psychological, symptoms [31]. It has been suggested that the burden of psychological symptoms is high among older people living with HIV [6, 32, 33], although few studies have assessed the association between age and anxiety. Our results showed a lower prevalence of psychological symptoms among older people living with HIV, which could be mediated by improved social, behavioural or economic circumstances in the older population (such as reduced recreational drug use). It is possible that the lower prevalences of anxiety and depression among older compared with younger people living with HIV reflect better adaptation to hardship in older adults, developed through their lifespan [34, 35], or 'resilience' [36], which has been found to be high in older HIV-diagnosed people [28, 37]. Alternatively, this could be an example of 'successful ageing' in HIV-diagnosed people; the ability to maintain mental health despite age-related health losses [37]. However, it could also reflect a 'survivor' selection effect towards psychological wellbeing.
The overall prevalence of health-related functional problems, as assessed by three domains of the EQ-5D-3L, increased with age. Similar patterns of results were found in other cross-sectional studies. A study using the WHOQOL-HIV [38] across eight (mainly low-income) countries found physical symptoms tended to be more common for older HIV-diagnosed people but mental health aspects were more favourable. Similarly, in the international START trial population, overall quality of life and the physical health component decreased with age, but the mental health component improved [25]. A multicentre US study found few differences by age in health-related quality of life among HIV-diagnosed people [18] using the HAT-Quality of Life scale, but in this scale daily function has a smaller role and psychosocial measures take precedence [39]. These results highlight the sensitivity of quality of life analyses to the specific instrument used, and weighting of domains within that instrument, and emphasize the importance of understanding contrasting trends across different health domains.
In contrast to older age, longer time with diagnosed HIV infection was strongly and independently related to poorer physical and psychological health across all measures studied, suggesting it may be a more important factor than chronological age in determining wellbeing among people living with HIV. The association between longer time with diagnosed HIV infection and poorer health is likely to be related to earlier calendar time of diagnosis: having been diagnosed at a time when HIV prognosis was poor, treatments were less effective or more complex, HIV-related stigma was greater, and companions and supportive networks may have been lost. However, it may also be related to increased time living with a chronic disease and its health and social implications, younger age at HIV diagnosis, the effects of prolonged HIV treatment, or the effect of longer time with untreated HIV infection specifically. The fact that, for most of the health measures, an association with time with diagnosed HIV infection was apparent even within the group diagnosed in the last ten years (from 2001/2002 to 2011/2012; a time of good prognosis) may give some support to the latter explanations as contributing factors. Future studies are needed to explore whether the strong effect of time with diagnosed HIV on health measures is related to ageing with HIV infection, or whether it primarily represents a historical effect of diagnosis in the pre-cART or early cART eras. Research assessing the effects on health of cumulative time with detectable vs undetectable viral load may also be valuable.
Studies assessing self-reported symptoms among people living with HIV are an important addition to those based on clinic data, as they provide information on health from the participant's perspective. ASTRA is the largest questionnaire study of HIV-diagnosed individuals in the UK to date, and one of the few to examine associations of age with symptoms, having accounted for time with diagnosed HIV infection. However, our study has several limitations. We have previously compared health-related quality of life utility score (using EQ-5D-3L) between the ASTRA participants and a large UK general population sample [17], but unfortunately there is no corresponding contemporary information on the prevalence of symptoms assessed using PHQ-9/GAD-7/MSAS-SF from UK general population studies to compare with results for the ASTRA sample. The study response rate was 64% overall, but there may have been differential nonresponse according to age which could cause bias in the assessment of age trends. Very few of the participants had severe mobility problems, which may be correlated to the ability to attend the clinic, and so may exclude a group with very poor health. Grouping all adults over 60 years old together prevents us from identifying age differences within this subgroup.
We aimed to assess the association of age with self-reported health measures with adjustment for key demographic factors for which the causal direction of association would be uncontroversial. Socio-economic [40-42], HIV- and treatment-related [[43],[44]], and lifestyle factors are worthy of future study as potential confounders or mediators of age effects.
This paper presents findings of age-related differences in wellbeing among people living with HIV and the independent effect of time with diagnosed HIV infection. Older people living with HIV are increasing in number globally [3] and health care systems will need to adapt to meet the needs of this ageing population. Quality of life, autonomy and self-rated health are essential components of successful ageing [34, 45]; our findings should inform the development of appropriate services for older HIV-positive people. These data do not support the hypothesis that older compared with younger people living with HIV have a disproportionate burden of symptoms. As psychological health appeared to be better among older participants, further exploration of 'successful ageing' among people with HIV and the positive effects of age on coping would be of value.
However, the strong and consistent associations between longer time with diagnosed HIV infection and poorer self-reported health, even after accounting for age, suggest the need for supportive strategies for people who have lived with HIV for a long period of time (including those diagnosed in the pre-cART period, or as younger adults), and emphasize the importance of regular care, and ongoing evaluation of psychological health, even for individuals who are virologically stable on ART. Independent associations of both older age and longer time since HIV diagnosis with physical health problems emphasize the importance of screening and assessment for age-related conditions among people under care for HIV infection, and prompt referral to suitable services.
For many symptom measures, we did not find continuous trends with age. Grouping older people together in an over-50s age group may miss important differences, such as possible improvements in symptom burden with older age. As the HIV-positive population ages, it will be important for future research to examine older age groups separately, as well as account for time since HIV diagnosis.

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