A systematic review on advance care planning for people living with HIV: insights from the studies of persons without HIV.

With advances in medicine, HIV has evolved into a chronic condition for people living with HIV (PLWH). However, many PLWH do not engage in advance care planning (ACP), and it occurs primarily in acute situations. ACP may improve preparedness for end-of-life care and increase advance directive (AD) documentation. Searches of PubMed, PsycInfo, and CINHAL were conducted to synthesize current ACP-related randomized controlled trials on two separate populations: (1) PLWH and (2) older adults without HIV. Two articles met inclusion criteria for PLWH, and the intervention had a significant improvement in ACP engagement. For the latter population, thirteen of fourteen articles had interventions that led to statistically significant increases in ACP engagement. This review underscores the need to further investigate the best strategies to improve ACP among PLWH and provides insights from existing ACP interventions for the general population to be adapted to the needs of PLWH.

Combined effects of social isolation and loneliness on patient-reported outcomes in older adults with HIV.

Social isolation exists when one has limited contact with others and is distinct from loneliness, an affective state on the perception of isolation. Less is known about the combined effects of social isolation and loneliness (SI/L) in older persons with HIV (OPWH). Using cross-sectional data on OPWH (age ≥50; N = 146), we assessed the overlap between SI/L and the separate and combined effects of SI/L on patient-reported outcomes (quality-of-life [QoL], HIV-related stigma, and depressive symptoms). Social isolation and loneliness were assessed using Social Network Index and the PROMIS-Social Isolation Scale, respectively, and based on each score, participants were grouped into four categories: "lonely only", "isolated only", "lonely+isolated", or "neither". Among participants (mean age = 56.53), 26.7% were considered "lonely only", 12.3% were "isolated only", 15.1% were "lonely+isolated", and 45.9% were "neither". Adjusted regression models showed that lonely+isolated group had more depressive symptoms and lower QoL than those considered "neither" or "isolated only" (p < .001) and that. The adjusted proportional odds model showed that the odds of stigma were 1.22 and 6.06 higher than those considered "neither" (p < .001) or "lonely only" (p = .016). Results demonstrate the combined effects of SI/L on patient-reported outcomes among OPWH. Findings highlight the need for approaches targeting OPWH who are lonely and isolated.

Brief virtual intervention associated with increased social engagement and decreased negative affect among people aging with HIV.

Virtual Villages-online communities that deliver supports to promote aging in place-are proposed to mitigate isolation and support the health of aging populations. Using a community-engaged approach, we developed and pilot-tested a Virtual Village intervention tailored for people living with HIV (PLWH) aged 50+ . The intervention employed a Discord server featuring social interaction, regional and national resources, expert presentations, and mindful meditation exercises. In 2022, a sample of PLWH aged 50+ from three U.S. study sites participated in a four-week pilot. Pre- and post-intervention surveys assessed participants' demographic characteristics; degree of loneliness, social connectedness, HIV-related stigma, and technology acceptance; mental wellbeing and physical health outcomes; and user experience. Participants (N = 20) were socioeconomically and racially/ethnically diverse, aged 51-88 years, and predominantly identified as gay or bisexual men (75%). Paired t-tests revealed a significant increase in participants' mean social engagement scores and a significant decrease in participants' mean negative affect scores, following the intervention. User experience scores were acceptable and participants reported a positive sense of connectedness to the Virtual Village community. Results suggest that a virtual community can be accessible to older PLWH and may enhance social engagement and improve aspects of mental wellbeing.

A Systematic Review of Self-Management Interventions Conducted Across Global Settings for Depressive Symptoms in Persons with HIV.

Depressive symptoms can affect health outcomes in people living with HIV (PLWH) including adherence to treatment and disease prognosis. Self-management interventions targeting depressive symptoms have been effective in preventing these negative sequelae of depressive symptoms. The processes of self-management include learning skills related to living with the illness needs, accessing resources to manage the illness, and coping with the illness. A systematic literature review was conducted to appraise and synthesize the current evidence of self-management interventions targeting depressive symptoms in PLWH. Following the PRISMA guidelines, an electronic search of 4 databases was conducted. Original studies written in English that used a randomized controlled trial design to test the effect of self-management intervention on depressive symptoms were included. Studies were selected that were published on/before April 19, 2022, thus yielding 13 relevant articles. Risk of bias was assessed using the NIH Quality Assessment Tool for Controlled Intervention Studies and narrative synthesis was used to synthesize the results. 40 to 755 participants were included in the studies, with each using various measures to assess depressive symptoms pre-and post-intervention, and timepoints for assessing depressive symptoms post-intervention varied. While 12 studies showed a significant reduction in depressive symptoms post-intervention, only 4 studies that used individual coaching or technology showed lower depressive symptoms in intervention groups in comparison to the control groups. This review can be used to inform scale-up and dissemination of these interventions to improve depressive symptoms in PLWH.

RESUMEN: Los síntomas depresivos pueden afectar el estado de salud en personas que viven con el VIH (PLWH, por sus siglas en inglés), incluyendo la adherencia al tratamiento y el pronóstico de la enfermedad. Las intervenciones de autocuidado enfocadas a los síntomas depresivos han sido eficaces para prevenir estas secuelas negativas de los síntomas depresivos. Los procesos de autogestión incluyen habilidades de aprendizaje relacionadas con enfocarse a vivir con la enfermedad necesidades, acceder a recursos para manejar la enfermedad y afrontar a la enfermedad. Se realizó una revisión sistemática de la literatura para evaluar y sintetizar la evidencia actual de las intervenciones de autocuidado dirigidas a los síntomas depresivos en personas que viven con el VIH. Siguiendo las directrices PRISMA, se realizó una búsqueda electrónica en 4 bases de datos. Se incluyeron estudios originales escritos en inglés que utilizaron un diseño de ensayo controlado aleatorio para evaluar el efecto de la intervención de autocuidado sobre los síntomas depresivos. Se seleccionaron estudios que se publicaron el 19 de abril de 2022 o antes, obteniendo 13 artículos relevantes. El riesgo de sesgo se evaluó mediante la herramienta de evaluación de la calidad de los NIH para estudios de intervención controlados y se utilizó la síntesis narrativa para sintetizar los resultados. Se incluyeron de 40 a 755 participantes en los estudios. Los estudios utilizaron diversas medidas para evaluar los síntomas depresivos antes y después de la intervención, y los puntos temporales para evaluar los síntomas depresivos después de la intervención variaron. Mientras que 12 estudios mostraron una reducción significativa en los síntomas depresivos después de la intervención, solo 4 estudios que usaron entrenamiento individual o tecnología mostraron síntomas depresivos más bajos en los grupos de intervención en comparación con los grupos de control. Esta revisión se puede utilizar para informar la ampliación y difusión de estas intervenciones para mejorar los síntomas depresivos en las personas que viven con el VIH.

Psychosocial Protective and Risk Factors of Quality of Life Outcomes Among Older Adults Living With HIV.

HIV continues to be a public health issue for older adults. Previous studies have examined predictors of quality of life (QoL) among people living with HIV (PLWH), but the majority have been in international settings and have not focused on older adults living with HIV (OALH). The aim of this study was to examine the associations between psychosocial protective and risk factors (resilience, internalized HIV-related stigma, and depression), and overall and domains (physical, psychological, independence, social, environmental, and spiritual) of QoL among OALH. Data were obtained from 156 OALH living in South Carolina. Resilience was positively associated with all QoL domains except the spiritual domain. Internalized HIV-related stigma was associated with all QoL domains except the psychological and environmental domains. Depression was associated with the overall QoL measure and all domains. Interventions aimed at increasing resilience, attenuating internalized HIV-related stigma and depressive symptoms may be warranted for OALH, which may improve overall and varying domains of QoL.

Social network size and its relationship to domains of quality-of-life among older persons living with HIV.

Gerontological research suggests that social network characteristics are key elements of successful aging as they are related to a positive quality-of-life (QoL). Less is known about the social networks of persons aging with HIV. To describe social network characteristics and assess the effect of social network size on QoL, a sample of 146 OPWH (age ≥50) was recruited from an outpatient HIV clinic in Atlanta, GA. Social network size was assessed using Cohen's social network index (SNI). Domains of QoL (physical, emotional, and social) were assessed using the RAND-36. Descriptive analyses were used to determine the frequency of contact within social networks and multivariable regression models were used to assess the relationship between SNI and three domains of QoL controlling for potential covariates. Participants were predominantly male (60%), heterosexual (63%), and African American (86%). Regular contact occurred most frequently with friends (82%) and relatives (77%). Multivariable modeling revealed that SNI explained 58% of the variance in emotional QoL (R2 = 0.58, F(8, 137) = 25.48, p < .001). Findings provide basis for potential interventions focused on the specific social network to improve emotional QoL of this vulnerable population.

Loneliness Mediates the Effect of HIV-related Stigma on Depressive Symptoms among Older Persons Living with HIV.

Studies have shown associations among stigma, loneliness, and depressive symptoms in older persons living with HIV (PWH) but research assessing the mediating pathway among these variables is sparse. Building on this prior work, the aim of this study was to test the mediating effects of loneliness. A sample of 146 older PWH (≥50 years old) from an outpatient HIV clinic in Atlanta, GA, completed a cross-sectional survey. Mediation analysis, guided by Baron and Kenny's criteria, was conducted using Stata v14.2 to assess the direct and indirect effects of loneliness on the association between stigma and depressive symptoms while controlling for covariates (sex; income; self-rated health; past unstable housing). Loneliness mediated the association between stigma and depressive symptoms. Stigma predicted higher loneliness, which in turn predicted more depressive symptoms. Findings suggest that addressing depressive symptoms in older PWH may require multifaceted interventions targeting psychosocial and interpersonal factors including stigma and loneliness.

A systematic review of engagement in care and health care utilization among older adults living with HIV and non-communicable diseases.

It is critical to understand health care engagement and utilization among older persons living with HIV (OPWH) who may have greater burden for non-communicable diseases. Following the PRISMA guidelines, a systematic review using 5 electronic databases was conducted to appraise and synthesize the current literature on the relationship of non-communicable diseases on engagement in care and health care utilization among OPWH. Original studies published in English between 2009 and 2019 were included, yielding 16 relevant articles. Overall, having co-morbid non-communicable diseases was associated with a decreased likelihood of initiating and adhering to ART. Being on ART and viral suppression were associated with better engagement in non-communicable disease care. Findings also suggest that an increasing number of co-morbidities is associated with higher health care utilization and financial burden. This review underscores the need for preventing and managing co-morbidities to enhance engagement in HIV care and that health care practitioners need to ensure that OPWH are engaged in care for both HIV and their co-morbid conditions by providing coordinated and integrated care.

Is Social Isolation Related to Emotion Dysregulation and Retention in Care Among Older Persons Living with HIV?

Retention in care is important in managing HIV among older persons living with HIV (PLWH). We used Theory of Loneliness-loneliness affects emotion-regulatory processes which lead to dysfunctional health behaviors-to test whether social isolation is related to retention in care either directly or indirectly through emotion dysregulation in older PLWH (≥ 50 years of age; N = 144). Retention in care was defined as the proportion of attended scheduled medical visits; visit data were collected prospectively over 12 months from electronic medical records. Self-reported social isolation, emotion dysregulation, and covariates were assessed cross-sectionally at baseline. Most participants were male (60%), African American/Black (86%), and single (59%); 56% were optimally retained in care. Retention was related to monthly income, CD4 + T cell count, and drug use with no direct or indirect effects of social isolation on retention in care. Socioeconomic and behavioral vulnerabilities are closely related to retention in care among older PLWH.

RESUMEN: Retención en atención médica es importante para el manejo de VIH con personas mayores que viven con VIH (PMVV). Nosotros usamos la Teoría de Soledad- soledad afecta los procesos que regulan emociones y crea comportamientos de salud disfuncionales- para probar si aislamiento social está asociado directamente o indirectamente con la retención en atención médica por desregular emociones en PMVV (≥ 50 años de edad; N = 144). Retención en atención médica fue definido por la proporción de visitas médicas programadas y atendidas; y los datos de visitas atendidas que fueron programadas fueron recopilados prospectivamente por 12 meses de archivos médicos electrónicos. Aislamiento social auto-reportado, desregulación emocional, y covariables fueron evaluados transversalmente de la línea de base. La mayoría de los participantes fueron masculinos (60%), negros/americanos africanos (86%) y solteros (59%); 56% de nuestra muestra fueron retenidos optimamente en atención médica. Retención en atención médica fue asociada con ingresos mensuales, el conteo de linfocitos cd4 + , y el consumo de drogas ilegales; no encontramos efectos directos ni indirectos del aislamiento social a la retención en atención médica. Vulnerabilidades socioeconómicas y de comportamiento están vinculados estrechamente a la retención en atención médica para PMVV.

Correlates of loneliness in older persons living with HIV.

Loneliness poses a significant risk for morbidity and mortality in the context of older adulthood. Research shows that older persons living with HIV (PLWH) often face increased and complex vulnerability in terms of physical and psychosocial needs which may promote loneliness. The current study sought to identify correlates of loneliness in a sample of 146 older PLWH (age ≥50) recruited from an outpatient HIV clinic in Atlanta, GA. Participants completed a survey on loneliness, depression, HIV-related stigma, social network size, HIV-disclosure status, disease burden, and demographics. HIV biomarkers were abstracted from electronic medical records. Participants were predominantly male (60%) and African American (86%). Twelve percent (n = 17) reported past homelessness/unstable housing. Multivariable modeling revealed that depression and HIV-related stigma explained 41% of the variance in loneliness, above and beyond the effects of past homelessness/unstable housing and disease burden (R2 = 0.41, F(7, 138) = 13.76, p < .001). Findings suggest that targeting HIV-related stigma and depression may reduce loneliness in older PLWH, but more studies are needed to elucidate causal pathways. A greater understanding of the mechanisms by which loneliness affects health among older PLWH could help better inform efforts to improve health in this patient population.

Cerebrovascular Contributions to Neurocognitive Disorders in People Living With HIV.

BACKGROUND: To investigate a comprehensive array of magnetic resonance imaging (MRI)-based biomarkers of cerebrovascular disease (CVD) in a cohort of people living with HIV (PLWH) and relate these imaging biomarkers to cognition. SETTINGS: Cross-sectional, community-based study. METHODS: Participants were PLWH in New York City, aged 50 years or older. They underwent a brain magnetic resonance angiography or MRI to ascertain 7 MRI markers of CVD: silent brain infarcts, dilated perivascular spaces, microhemorrhages, white matter hyperintensity volume, white matter fractional anisotropy and mean diffusivity (measures of white matter integrity), and intracranial large artery stenosis. Participants underwent a battery of neurocognitive tests to obtain individual and global cognitive scores representative of various aspects of cognition. RESULTS: We included 85 participants (mean age 60 ± 6 years, 48% men, 78% non-Hispanic Black), most of them with well-controlled HIV (75% with CD4 cell count > 200 cells/mm3 and viral load < 400 copies/mL at or near the time of the MRI scan). Silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity were associated with poorer performance in at least one cognitive domain, but the sum of these 3 MRI markers of CVD was associated with lower working memory (B = -0.213, P = 0.028), list learning (B = -0.275, P = 0.019), and global cognition (B = -0.129, P = 0.007). CONCLUSIONS: We identified silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity as exposures that may be modifiable and may, therefore, influence cognitive decline. In addition, these MRI markers of CVD may help in identifying PLWH at higher risk of cognitive decline, which may be more amenable to targeted therapies.

Associations of Mood on Objective and Subjective Cognitive Complaints in Persons Living with HIV/AIDS.

Healthcare workers commonly rely on patient self-report to identify problems with cognitive functioning among Persons Living with HIV (PLWH). Self-reported cognitive complaints may not accurately reflect objective cognitive performance and may be obscured by co-occurring depression. The purpose of the current study was to examine the relationships among depression, subjective cognitive complaints, and objective cognitive performance in PLWH using measures easily administered by healthcare workers. Particularly, this study assessed the association between subjective cognitive complaints (MOS-HIV) and objective cognitive performance (mHDS) using a simple screening tool, as well as whether depressive symptoms (CES-D 10) moderated this relationship. This was a secondary data analysis of a parent study that enrolled participants (N=207) from outpatient HIV clinics in Florida between 2009 and 2011. Most participants identified themselves as African American (82.6%) and heterosexual (81.6%). Almost half of the participants were male (46.4%). Fifty-one percent of participants had a score of 10 or greater on CES-D, indicating clinical depression. This study found no association between subjective and objective cognitive measures; depressive symptoms exhibited no moderating effect on the relationship between subjective cognitive complaints and objective cognitive performance. Depressive symptoms were significantly associated with subjective perceptions of cognitive ability. Results suggest that subjective cognitive complaints may be an inadequate tool for identifying objective cognitive impairments among PLWH. Additionally, treatment of depressive symptoms may help alleviate subjective cognitive complaints.

A Structural Equation Model of HIV-related Symptoms, Depressive Symptoms, and Medication Adherence.

Adherence to combined antiretroviral therapy (cART) remains critical in management of HIV infection. This study evaluated depression as a potential mechanism by which HIV-related symptoms affect medication adherence and explored if particular clusters of HIV symptoms are susceptible to this mechanism. Baseline data from a multi-visit intervention study were analyzed among 124 persons living with HIV (PLWH). A bifactor model showed two clusters of HIV-related symptom distress: general HIV-related symptoms and gastrointestinal (GI) symptoms. Structural equation modeling showed that both general HIV-related symptoms and GI symptoms were related to higher levels of depressive symptoms, and higher levels of depressive symptoms were related to lower levels of medication adherence. Although general HIV-related symptoms and GI symptoms were not directly related to adherence, they were indirectly associated with adherence via depression. The findings highlight the importance of early recognition and evaluation of symptoms of depression, as well as the underlying physical symptoms that might cause depression, to improve medication adherence.

The Role of Depression in Retention in Care for Persons Living with HIV.

Individuals infected with HIV experience high rates of depression when compared to their sero-negative counterparts. Although symptoms of depression have been consistently linked to poor medication adherence among persons living with HIV/AIDS, their relation to retention in care are less well-known. The purpose of this study was to examine whether clusters of depressive symptoms influence retention in care and if so, whether these clusters had different relations to retention in care. This is a secondary data analysis of a larger study that investigated the role of health literacy, cognitive impairment, and social determinants on retention in HIV care. Individuals with HIV were recruited from South Florida from August 2009 to May 2011. A total of 210 participants were included in the current analyses. A measure of visit constancy was calculated to represent the number of 4-month intervals with at least one kept visit. Individual items on the Center for Epidemiological Studies Depression Scale short form (CES-D10) and factor analysis of the CES-D10 were independent variables. Overall, there was a high prevalence of depressive symptoms in the study participants. Furthermore, factor analysis showed that certain clusters of depressive symptoms were significantly associated with visit constancy. Specifically, negative mood/somatic symptoms were associated with a greater odds of missing a visit in any of the observed 4-month time periods than positive mood factor. Those patients reporting somatic symptoms and negative mood may need additional intervention and support to be effectively retained in care and successfully follow through with appointments and care.

The Role of Employment on Neurocognitive Reserve in Adults With HIV: A Review of the Literature.

The benefits of employment are enormous; when employed, people naturally: (a) engage socially with the public and colleagues/co-workers, (b) learn new skills to increase job productivity and competence, (c) establish routines that can prevent lethargy and boredom and may regulate sleep and healthy behaviors, (d) are provided purposeful and meaningful activity that may prevent depression, and (e) gain income to pursue cognitively stimulating interests. All of these and other employment influences can provide an enriched personal and social environment that stimulates positive neuroplasticity and promotes neurocognitive reserve, which are particularly relevant to adults with HIV because (a) approximately 50% of adults with HIV experience observable cognitive impairments that can adversely affect everyday functioning such as medication adherence, and (b) approximately 45% of adults with HIV are unemployed and do not receive the neurocognitive benefits of employment. From these considerations, implications for health care research and nursing practice are provided.