The association between HIV infection, disability and lifestyle activity among middle-aged and older adults: an analytical cross-sectional study in Ivory Coast (the VIRAGE study)

Abstract

Introduction: People living with HIV (PLWH) live longer and face new health challenges resulting from the confluence of chronic HIV infection and the natural effect of aging and comorbidities. However, there is a dearth of information on the long-term impact of HIV infection on the health and wellbeing of PLWH in sub-Saharan Africa. This research aimed to fill this gap by reporting on physical, functional and social outcomes among PLWH treated at a referral center in Abidjan, Ivory Coast, and comparing them with those of a control group.

Methods: Body composition, functional capacity, sarcopenia, limitations in daily activities and social participation were assessed among 300 PLWH (aged ≥ 30 years) and 200 uninfected adults of similar age and sex. The associations between these outcomes and participants' socioeconomic characteristics, HIV history and physical activity level were assessed using generalized additive models adjusted for age and sex.

Results: The median age was 51 years, and the median antiretroviral therapy duration was 15 years. Compared to controls, PLWH reported higher levels of physical activity (p < 0.0001). They had a lower muscle index (adjusted p < 0.0001) and grip strength (adjusted p < 0.0001) but achieved similar performance on the 6-min walk test (6MWT, p = 0.2). Among PLWH, physical activity level was positively associated with better performance in the 6MWT (p = 0.006) and greater hand grip strength (p = 0.04). The difference in physical performance according to the level of physical activity appeared mainly after the age of 60. PLWH reported similar rates of activity limitations (p = 0.8), lower depression levels and greater scores for social functioning (p = 0.02).

Conclusion: In this study, PLWH achieved high levels of physical activity, which may explain why they maintained good physical performance and social functioning despite having a higher risk of sarcopenia. These results have important implications for resource-limited health systems and show avenues for chronic care models.

Trial registration: This study was registered on the ClinicalTrials.gov website (NCT05199831, first registration the 20/01/2022).

Keywords: Aging; Disability; HIV; Physical activity.

Fig. 1

Shape of the association between physical capacities (6MWT, 5STS), grip strength and the skeletal muscle index and age and physical activity levels. Green and red lines represent the fitted outcomes using GAMs adjusted for age among PLWH who reported high physical activity (green) and low physical activity (red). The gray lines represent the 25%, 50% and 75% quantile estimates for HIV-uninfected participants overall. Note that lower 5STS time indicates greater physical capacity. kg: kilogram

Fig. 2

Association between physical performance outcomes (6MWT, 5STS, grip strength and muscle index) and factors related to HIV infection and treatment characteristics (ART duration, CD4 nadir, history of virologic failure, history of treatment with D4T, DDI or ZDV)