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Themes of Aging from Older PLWH: A fog that impacts everything:
understanding quality of life in people living with HIV and cognitive impairment
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18th European AIDS Conference Oct 27-30
K. Alford1, S. Daley2, S. Banerjee3, J. Vera4,5
1Brighton and Sussex Medical School, Global health and Infection, Brighton, United Kingdom, 2Brighton and Sussex Medical School, Centre for Dementia Studies, Brighton, United Kingdom, 3University of Plymouth, Faculty of Health, Plymouth, United Kingdom, 4Brighton and Sussex Medical School, Department of Medicine, Brighton, United Kingdom, 5Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom
Purpose or Objective
Despite effective antiretroviral treatment, cognitive impairment (CI) in people living with HIV (PLWH) is an increasingly important health concern in the context of an ageing HIV population. Mild to moderate CI is conservatively seen in 14-28% of PLWH, with individuals reporting lower quality of life (QoL) compared to matched controls. The purpose of this study was to explore QoL experiences and the dimensions comprising this essential patient-reported outcome in PLWH with CI.
Results
In depth, semi-structured, qualitative interviews and team-based analysis of transcripts, using grounded theory techniques, to identify codes, categories, and themes relating to the impact of CI in PLWH on QoL. PLWH (maximum variation purposively sampled by age, gender, ethnicity, and sexuality) with objective CI considered at least in part to HIV disease (diagnosed via multidisciplinary working by specialist HIV memory services) were recruited.
Materials and Methods
25 PLWH were recruited from 2 UK HIV services: median age 56 years (range 35-80); 44% white British, 32% Black African; 56% men that have sex with men, 40% heterosexual; 44% mild CI, 40% moderate CI, 16% severe CI (based on Montreal Cognitive Assessment scores). Analysis revealed seven broad inter-related dimensions influencing QoL experiences in PLWH with CI (Table 1).
Conclusion
PLWH with CI generally appraised their QoL poorly and described impacts of CI on QoL across physical, psychological, and social functioning. In addition, direct effects of cognitive symptoms, experiences associated with living with HIV, perceptions of control, along with acceptance of conditions emerged as important factors impacting on QoL experiences. QOL is a key outcome in HIV clinical care and viewed as both a predictor and mediator of successful ageing. The broad impacts of CI is an important consideration, influencing QoL in distinct ways. Understanding QoL is essential for researchers seeking to develop assessment tools and design interventions aimed at targeting this important outcome.
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