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Aging with HIV? I'm fine, thanks for asking! - 14% Age Well in Canada Cohort
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Reported by Jules Levin
9th International Workshop on HIV & Aging
New York
Sept 13-14 2018
Nancy Mayo, Marie-Josée Brouillette, Lesley Fellows
The Positive Brain Health Now investigators
Program Abstract
Aging with HIV: I'm fine, thanks for asking
Mayo N1, Brouillette M1,7, Harris M3,7, Thomas R4, Smith G5, Smaill F6,7, Fellows L2,7
1Research Institute of the McGill University Health Centre, Montréal, Canada, 2Dept of Neurology & Neurosurgery, McGill University, Montreal Neurological Institute, Montreal, Canada, 3BC Centre for Excellence in HIV/AIDS, Department of Family Practice, University of British Columbia, Vancouver, Canada, 4Clinique médicale L'Actuel, Montreal, Canada, 5Maple Leaf medical clinic, University of Toronto, Toronto, Canada, 6McMaster UniversityDepartment of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada, 7CIHR Canadian HIV Trials Network, Vancouver, Canada
Background: Much attention is being paid to frailty in people aging with HIV. Less attention is paid to those doing "well - thank you" yet much could potentially be learned from those doing well.
Objective: The purpose of this study is to describe the profile of people who are aging well with HIV to identify factors that place people at promise for aging well.
Methods: Data from the inaugural visit for people enrolled in the Brain Health Now cohort were analyzed cross-sectionally. Aging well was measured using the 8 subscales of the SF-36, a well-known and widely used measure of the health aspects of quality of life: Physical Function (PF), Pain, Vitality (VIT), Social Function (SF), Role Physical (RP), Role Emotional (RE), Mental Health (MH) and one question from General Health Perception (GHP) for self-rated health. Normative data from the Canadian population was used to classify people at or above norms for age and sex on each sub-scale. People with data on all these measures so classified on 7 or 8 of the 8 subscales were defined as aging well. Promise factors covered domains of socio-demographic, HIV, co-morbidity, life-style, social support, loneliness, stigma, and cognition.
Results: A total of 806 people, out of the original cohort of 856 persons (mean age 53; range 35 to 81 years), had all the data necessary to be classified as aging well (685 men and 121 women).
The most common health profile (n=154; 19%) is none of the SF-36 subscales at norm.
The second most common profile is all at norm (n=59; 7%).
The third most common profile is only PF at norm (n=43; 5%).
A total of 113 people met our aging well criteria (14%), 97 men and 16 women.
Variables unrelated to aging-well status were age, sex, Nadir CD4, BMI, current smoking, cardiovascular risk, and hours of engagement in meaningful activities.
Variables showing promise for aging well were university education, having friends or family, social drinking, not being lonely, low stigma, better cognitive performance, fewer self-reported cognitive concerns, being vigorously active, and lower levels of inflammation (CRP).
Discussion: While it is not possible with this cross-sectional view to sort out the "chicken or the egg", many of the promise factors are early life-course variables (education, friends, physical activity and inflammation), while others are more likely to contribute to aging well (stigma, loneliness, cognition) rather than being a consequence. Maintaining physical activity, cognition, and social network are three variables showing promise for aging well with HIV.
This study showed that 14% met our criteria for "superstar" status, this is in contrast to only 8% meeting criteria for frailty. Focusing on people aging well with HIV could be a fruitful avenue to explore to not only promote successful aging with HIV but also to identify ways of preventing or arresting frailty.
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