Abstract
BackgroundUnlike their younger counterparts, some of today’s older HIV patients were diagnosed before the advent of highly active antiretroviral therapy (HAART). The psychosocial and behavioral outcomes of people living with HIV (PLWH) have been widely studied, and associated factors are well known. However, their evolution both in terms of age and diagnosis-specific cohort effects is not well understood.MethodsData from the ANRS-VESPA2 cross-sectional survey, representative of French PLWH, were used to investigate whether psychosocial and behavioral outcomes such as quality of life, need for support and HIV status disclosure, evolve under both the influence of patients’ age and diagnosis-specific cohort effects. A semi-parametric generalized additive model (GAM) was employed. The physical and mental components of health-related quality of life, the need for material and moral support, and HIV-status disclosure, constituted our outcomes.ResultsNon-linear diagnosis-specific cohort effects were found for physical and mental QoL and HIV-status disclosure. Overall, physical QoL was better in recently diagnosed patients than in those diagnosed in the early 1980s. An increasing influence of diagnosis-specific cohort effects between 1983 and 1995 was observed. No cohort effects were noticeable between 1996 and 2000, while an increasing influence was apparent for patients diagnosed with HIV from 2000 to 2011 (year of study). For mental QoL, the only increase was observed in participants diagnosed with HIV between 1983 and 2000. The relationship between diagnosis-specific cohort effects and HIV status disclosure was negative overall: participants diagnosed after 2000 were much less likely to disclose than those diagnosed before 1995. The effect of age was significantly associated with all outcomes, with a non-linear influence on mental QoL and with the need for material/moral support.ConclusionsPsychosocial and behavioral outcomes are complex processes which can be explained in different ways by a combination of the clinical and social contexts which PLWH are exposed to at the time of diagnosis, and by developmental characteristics. A greater understanding of these processes could inform healthcare policy-making for specific HIV generations and different HIV age groups.
Highlights
Unlike their younger counterparts, some of today’s older Human immunodeficiency virus (HIV) patients were diagnosed before the advent of highly active antiretroviral therapy (HAART)
Psychosocial and behavioral outcomes are complex processes which can be explained in different ways by a combination of the clinical and social contexts which people living with HIV (PLWH) are exposed to at the time of diagnosis, and by developmental characteristics
A greater understanding of these processes could inform healthcare policymaking for specific HIV generations and different HIV age groups
Summary
Some of today’s older HIV patients were diagnosed before the advent of highly active antiretroviral therapy (HAART). This is methodologically challenging for several reasons: i) the complex composition of the population of PLWH in terms of age and year of diagnosis, ii) the complex evolution of HIV care, which has seen improvements in diagnosis, treatment and health care programs lead to HIV becoming a chronic disease, and iii) the relationship between the timing of these improvements and aging Unlike their younger HIV counterparts, some of today’s older patients were diagnosed and treated before the advent of highly active antiretroviral therapy (HAART) with serious negative consequences on their health-related quality of life due to the toxicity of older drugs such as stavudine, zidovudine and nevirapine [1]. We argue that variations in psychosocial and behavioral outcomes among PLWH can be attributed to individual differences and to the different clinical and social contexts which they were confronted with at the time of HIV diagnosis, represented by diagnosis-specific cohort effects
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