Summary

This study examines successful aging in people with HIV and aims to identify factors that contribute to maintaining good health-related quality of life (HRQL) over time. Successful aging is defined as being at or above population norms on 7 or 8 of 8 health-related quality of life domains from a measure often used in health research, the RAND-36. The Positive Brain Health Now cohort, comprising people with HIV aged 50 and above, was analyzed for this study. The results showed that 14.4% of the cohort met the criteria for successful aging at study entry and this status was maintained over 3 years. The study identified factors related to successful aging, which were mostly non-medical, including resilience factors such as not feeling lonely, feeling safe and, as well as a good social network and enough money to meet one’s needs. The absence of arthritis and lung disease also correlated with successful aging. In conclusion, this study sheds light on the factors associated with successful aging in people with HIV. It suggests that addressing social determinants of health and providing resources can promote successful aging and improve quality of life for this population.

Abstract

Purpose

The purpose of this study is to estimate the extent to which people aging with HIV meet criteria for successful aging as operationalized through HRQL and maintain this status over time. A second objective is to identify factors that place people at promise for continued successful aging, including environmental and resilience factors.

Methods

Participants were members of the Positive Brain Health Now (BHN) cohort. People ≥ 50 years (n = 513) were classified as aging successfully if they were at or above norms on 7 or 8 of 8 health-related quality of life domains from the RAND-36. Group-based trajectory analysis, regression tree analysis, a form of machine learning, and logistic regression were applied to identify factors predicting successful aging.

Results

73 (14·2%) met criteria for successful aging at entry and did not change status over time. The most influential factor was loneliness which split the sample into two groups with the prevalence of successful aging 28·4% in the “almost never” lonely compared to 4·6% in the “sometimes/often” lonely group. Other influential factors were feeling safe, social network, motivation, stigma, and socioeconomic status. These factors identified 17 sub-groups with at least 30 members with the proportions classified as aging successfully ranging from 0 to 79·4%. The nine variables important to classifying successful aging had a predictive accuracy of 0.862. Self-reported cognition but not cognitive test performance improved this accuracy to 0.895. The two groups defined by successful aging status did not differ on age, sex or viral load, nadir and current.

Conclusion

The results indicate the important role of social determinants of health in successful aging among people living with HIV.

DOI: https://doi.org/10.1007/s11136-021-02970-7

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