Synergistic effects of HIV infection and older age on daily functioning

Abstract

Objective: To determine whether HIV infection and aging act synergistically to disrupt everyday functioning.

Design: Cross-sectional factorial study of everyday functioning in the context of HIV serostatus and age (≤40 years vs. ≥50 years).

Methods: One hundred three HIV+ and 87 HIV- participants were administered several measures of everyday functioning, including self-report indices of health-related quality of life (HRQoL) and instrumental and basic activities of daily living (IADLs and BADLs), and objective measures of functioning, including employment and Karnofsky Performance Scale ratings.

Results: Significant interaction effects of HIV and aging were observed for IADL and BADL declines, and for Karnofsky Performance Scale ratings (Ps < 0.05), independent of potentially confounding factors. Follow-up contrasts revealed significantly worse functioning in the older HIV+ group for most functional outcome measures relative to the other study groups (Ps < 0.05). A significant interaction effect was also observed on the emotional functioning HRQoL subscale, and additive effects of both age and HIV were observed for the physical functioning and general health perceptions HRQoL subscales (Ps < 0.05). Significant predictors of poorer functioning in the older HIV+ group included current major depressive disorder for all outcomes, and comorbid medical conditions, lower estimated premorbid functioning, neurocognitive impairment, and nadir CD4 count for selected outcomes.

Conclusion: Findings suggest that older age may exacerbate the adverse effects of HIV on daily functioning, which highlights the importance of evaluating and monitoring the functional status of older HIV-infected adults. Early detection of functional difficulties could facilitate delivery of compensatory strategies (eg, cognitive remediation) or assistive services.

Figure 1

Significantly greater severity of IADL and BADL decline severity among old HIV+ individuals relative to all other groups (ps < 0.001). Note. IADL = instrumental activities of daily living; BADL = basic activities of daily living; Cohen's d effect sizes of the difference between old HIV+ and all other groups on IADL decline severity were as follows: young HIV+ = 0.42; old HIV− = 0.71; young HIV− = 0.56. Cohen's d effect sizes of the difference between old HIV+ and all other groups on BADL decline severity were as follows: young HIV+ = 0.40; old HIV− = 0.67; young HIV− = 0.63.

Figure 2

Higher rates of unemployment and lower Karnofsky Performance Status (KPS) scores among the older HIV+ individuals Note. Omnibus group differences significant (ps < .001); Cohen's d effect sizes of the difference between old HIV+ and all other groups on KPS scores were as follows: young HIV+ = −0.89; old HIV− = −0.99; young HIV− = −1.50.