Evaluating healthy aging among Canadian HIV-positive older adults in the CHANGE HIV cohort


BACKGROUND: Life expectancy among people living with HIV (PLWH) is approaching that of the general population, however, PLWH continue to experience greater burden and earlier onset of medical comorbidities. Important differences in clinical outcomes and quality of life persist. Examining healthy aging as a multidimensional state can guide development of preventative and management strategies that are appropriate for the complex social and healthcare needs of people aging with HIV.
METHODS: The CHANGE HIV (Correlates of Healthy Aging iN GEriatric HIV) study is a Canadian cohort of PLWH age 65 or older. In this cohort, healthy aging is assessed using the Rotterdam Healthy Aging Score (HAS), calculated across 7 domains of health (chronic disease, mental health, pain, social support, quality of life, cognitive and physical function). We report on the HAS for the first 227 participants in the cohort and determine the proportion of those with healthy (scores 13-14), intermediate (scores 11-12), and poor aging (scores 0-10) scores. Scores were compared based on sociodemographic and HIV-related factors using Kruskal-Wallis and Fisher''s exact tests.
RESULTS: Median [IQR] age was 70 [68,74], majority of participants were men (89%), white (77%), born in Canada (66%) and retired (77%). Median [IQR] HAS was 12 [10,13] with 34% of participants achieving healthy, 39% intermediate and 27% poor aging scores. Women and transgender participants had lower median [IQR] HAS (10.5 [9,13] compared to 12 [11,13] among men) and higher proportion of poor aging scores (50% compared to 24% among men, p=0.015). Women had fewer comorbidities compared to men (p=0.024), but worse cognitive function scores (p=0.002) and more pain (p<0.001). HAS scores were lower among retired individuals compared to those employed or engaged in volunteer activities (p=0.013) but did not differ by age (p=0.641), race (p=0.698), country of birth (p=0.887), CD4 count nadir (p=0.510), or duration of HIV infection (p=0.066).
CONCLUSIONS: Gender seems to have an important impact on the aging experience of PLWH, especially across comorbidity, cognitive function and pain domains of health. Using a multidimensional score like the HAS can identify individuals at risk of poor clinical outcomes and direct interventions that support their healthy aging.

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