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Almost Half of Older HIV+ Adults Report
Poor Overall Health in 25-Country Survey
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AIDS 2020: 23rd International AIDS Conference Virtual, July 6-10, 2020
IAC 2020 Virtual: Clinical and sociodemographic characteristics associated with poor self-rated health across multiple domains among older adults living with HIV - (07/10/20)
Mark Mascolini
Nearly half of 50-or-older HIV-positive people in an international survey (46%) reported suboptimal overall health [1]. Nearly as many (44%) reported suboptimal physical health, and well over half claimed poor sexual health.
Guided by the World Health Organization view that “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” [2], ViiV Healthcare researchers and collaborators undertook this analysis of the 2019 Positive Perspectives survey. From April through August 2019, this web-based survey asked adults with HIV in 25 countries to self-report their health in four domains: physical, mental, sexual, and overall. Researchers grouped responses into two categories—optimal (including the responses “Good” or “Very good”) and suboptimal (“Neither good nor poor,” “Poor,” or “Very poor”). The investigators used multinomial logistic regression to identify sociodemographic and clinical predictors of suboptimal health in all four domains.
This analysis focused on 699 survey respondents 50 years old or older, representing 29% of the 2389 total respondents. The older group had been diagnosed with HIV infection for a median of 19 years, 83% had 1 or more comorbidities, and 55% took 5 or more pills daily or took medications for 5 or more conditions (defined as polypharmacy).
Nearly half (46.1%) of these 699 older people with HIV reported suboptimal overall health, and almost that many (44.1%) thought they had suboptimal physical health. Six in 10 respondents (60.5%) reported suboptimal sexual health, and well over one third (38.2%) had suboptimal mental health. Physical health correlated most strongly with overall health (Spearman’s correlation, rho = 0.75), followed by mental health (rho = 0.68).
In an analysis adjusted for age and sex, suboptimal overall health was most frequent in Asia (47%), followed by Europe (45%), North America and Latin America (each 44%), Australia (37%), and South Africa (32%). Suboptimal physical health proved most prevalent in Asia (46%), followed by North America and Latin America (each 43%), Europe (42%), Australia (36%), and South Africa (31%).
Almost one quarter of respondents (23%) reported suboptimal health in all four domains (physical, mental, sexual, and overall), while 17% claimed suboptimal health in three domains, 12% in two domains, 23% in one domain, and 26% in no domains. In North America, 21% of respondents felt suboptimal health in four domains, 22% in three domains, 14% in two domains, 21% in one domain, and 22% in no domains. In South Africa proportions reporting suboptimal health in 4, 3, 2, 1, and 0 domains were 16%, 6%, 23%, and 55%.
Logistic regression identified 12 independent predictors of reporting suboptimal health in all four domains (versus no domains): past major drug-drug interaction, gastrointestinal antiretroviral side effects versus none, polypharmacy, one comorbidity or two or more comorbidities versus none, coinfections, substance use, internalized HIV stigma versus none, both internalized stigma and anticipated stigma versus none, missing 2 to 4 days of antiretroviral therapy versus none in the past month, missing 5 or more days of antiretroviral therapy versus none in the past month, and being dissatisfied with treatment versus satisfied.
The researchers urged clinicians to adopt a “holistic approach to [HIV] care . . . seeking improvements in all aspects of health and considering patients as a whole.”
References
1. Short D, Spinelli F, Okoli C, de los Rios P. Clinical and sociodemographic characteristics associated with poor self-rated health across multiple domains among older adults living with HIV. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract OAD0903.
2. World Health Organization. https://www.who.int/about/who-we-are/constitution
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