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. 2025 Mar;28(3):e26434.
doi: 10.1002/jia2.26434.

Comorbidities and HIV-related factors associated with mental health symptoms and unhealthy substance use among older adults living with HIV in low- and middle-income countries: a cross-sectional study

Jeremy L Ross  1 , Dhanushi Rupasinghe  2 , Thida Chanyachukul  1 , Brenda Crabtree Ramírez  3 , Gad Murenzi  4 , Edith Kwobah  5 , Fiona Mureithi  6 , Albert Minga  7 , Ivan Marbaniang  8 , Hugo Perazzo  9 , Angela Parcesepe  10 , Suzanne Goodrich  11 , Cleophas Chimbetete  12 , Ephrem Mensah  13 , Fernanda Maruri  14 , Dung Thi Hoai Nguyen  15 , Alvaro López-Iñiguez  3 , Kathryn Lancaster  16 , Helen Byakwaga  17 , Mpho Tlali  18 , Marie K Plaisy  19 , Smita Nimkar  8 , Rodrigo Moreira  9 , Kathryn Anastos  20 , Aggrey Semeere  21 , Gilles Wandeler  22 , Antoine Jaquet  19 , Annette Sohn  1 ; Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS
Affiliations

Comorbidities and HIV-related factors associated with mental health symptoms and unhealthy substance use among older adults living with HIV in low- and middle-income countries: a cross-sectional study

Jeremy L Ross et al. J Int AIDS Soc. 2025 Mar.

Abstract

Introduction: People with HIV (PWH) are vulnerable to mental health and substance use disorders (MSDs), but the extent to which these are associated with other non-communicable diseases in ageing PWH populations remains poorly documented. We assessed comorbidities associated with symptoms of MSD among PWH ≥40 years in the Sentinel Research Network (SRN) of the International epidemiology Database to Evaluate AIDS (IeDEA).

Methods: Baseline data collected between June 2020 and September 2022, from 10 HIV clinics in Asia, Latin America and Africa contributing to the SRN, were analysed. Symptoms of MSDs and comorbidities were assessed using standardized questionnaires, anthropometric and laboratory tests, including weight, height, blood pressure, glucose, lipids, chronic viral hepatitis and liver transient elastography. HIV viral load, CD4 count and additional routine clinical data were accessed from participant interview or medical records. HIV and non-HIV clinical associations of mental illness symptoms and unhealthy substance use were analysed using logistic regression. Mental illness symptoms were defined as moderate-to-severe depressive symptoms (PHQ-9 score >9), moderate-to-severe anxiety symptoms (GAD-7 >9) or probable post-traumatic stress disorder (PCL-5 >32). Unhealthy substance use was defined as ASSIST score >3, or AUDIT ≥7 for women (≥8 for men).

Results: Of 2614 participants assessed at baseline study visits, 57% were female, median age was 50 years, median CD4 was 548 cells/mm3 and 86% had HIV viral load <1000 copies/ml. Overall, 19% had mental illness symptoms, 15% unhealthy substance use, 49% BMI >25 kg/m2, 38% hypertension, 15% type 2 diabetes, 35% dyslipidaemia, 34% liver disease and 23% history of tuberculosis. BMI >25 and dyslipidaemia were found in 54% and 40% of those with mental illness symptoms compared to 49% and 34% of those without. Mental illness symptoms were not significantly associated with the clinical factors assessed. Unhealthy substance use was more likely among those with dyslipidaemia (OR 1.55, CI 1.16-2.09, p = 0.003), and less likely in those with BMI >25 (OR 0.48, CI 0.30-0.77, p = 0.009).

Conclusions: Improved integration of MSD and comorbidity services in HIV clinical settings, and further research on the association between MSD and comorbidities, and care integration among older PWH in low-middle-income countries, are required.

Keywords: HIV; ageing; coinfections; comorbidities; mental health; substance use.

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Conflict of interest statement

AUTHORS’ CONTRIBUTIONS

JLR developed the research concept with support from DR, TC, AP, KL and AS. DR analysed the data. JLR interpreted the data and drafted the manuscript, with input from DR. TC, BCR, GM, FM, AM, IM, HP, AP, SG, CC, EM, FM, DTHN, AL‐I, KL, HB, MT, MKP, RM, AS, GW, AJ and AS reviewed manuscript drafts. All authors have read and approved the final manuscript.

Figures

Figure 1
Figure 1
Clinical factors among participants. Bar chart of numbers and proportions of clinical factors among participants with and without symptoms of mental illness and unhealthy substance use.
See this image and copyright information in PMC

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