A Longitudinal View of Successful Aging With HIV: Role of Resilience and Environmental Factors

Abstract

Background: Much attention is paid to the negative aspects of aging with HIV. Less is known about those doing well, yet much could be learned from those aging successfully. Objective: The purpose of this study is to estimate the extent to which people aging with HIV met criteria for successful aging and maintained this status over time. A second objective was to identify factors that placed people at promise for successful aging. Methods: Participants were members of the Positive Brain Health Now (BHN) cohort which recruited from five Canadian sites (2014-2016) with prospective follow-up over 27 months. People ≥50 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. Promise factors covered socio-demographic, HIV, co-morbidity, lifestyle, resilience, and environmental domains. Group-based Trajectory Analysis, logistic regression and regression tree analysis, a form of machine learning, were applied. Results: Of the 513 people age ≥50 at study entry, 73 (14·2%) met criteria for successful aging at entry and over time. The most influential factor was loneliness: splitting the sample into two groups with the prevalence of successful aging 28·4% in the not-lonely compared to 4·6% in the lonely. 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%. Conclusion: The results indicate the important role of social determinants of health in successful aging in people with HIV. Funding Statement: This project was supported by grants from the Canadian Institutes of Health Research (LKF,MJB, NM, TCO-125272), the CIHR Canadian HIV Trials Network (CTN 273), and salary support from the Fonds de Recherche Sante du Quebec (LKF) and the Research Institute of the McGill University Health Centre (MJB). Declaration of Interests: Authors declare that they have no conflicts of interest. Ethics Approval Statement: All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The project was approved by the Research Ethics Board of each of the participating institutions. All participants provided informed consent.