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Synergistic Effects of HIV Infection and Older Age on Daily Functioning

Morgan, Erin E. PhD*; Iudicello, Jennifer E. PhD*; Weber, Erica MS; Duarte, Nichole A. PhD*; Riggs, P. Katie BS; Delano-Wood, Lisa PhD*,§; Ellis, Ronald MD, PhD; Grant, Igor MD*; Woods, Steven P. PsyD*For The HIV Neurobehavioral Research Program (HNRP) Group

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1st, 2012 - Volume 61 - Issue 3 - p 341–348
doi: 10.1097/QAI.0b013e31826bfc53
Clinical Science

Objective: To determine whether HIV infection and aging act synergistically to disrupt everyday functioning.

Design: Cross-sectional factorial study of everyday functioning in the context of HIV serostatus and age (≤40 years vs. ≥50 years).

Methods: One hundred three HIV+ and 87 HIV− participants were administered several measures of everyday functioning, including self-report indices of health-related quality of life (HRQoL) and instrumental and basic activities of daily living (IADLs and BADLs), and objective measures of functioning, including employment and Karnofsky Performance Scale ratings.

Results: Significant interaction effects of HIV and aging were observed for IADL and BADL declines, and for Karnofsky Performance Scale ratings (Ps < 0.05), independent of potentially confounding factors. Follow-up contrasts revealed significantly worse functioning in the older HIV+ group for most functional outcome measures relative to the other study groups (Ps < 0.05). A significant interaction effect was also observed on the emotional functioning HRQoL subscale, and additive effects of both age and HIV were observed for the physical functioning and general health perceptions HRQoL subscales (Ps < 0.05). Significant predictors of poorer functioning in the older HIV+ group included current major depressive disorder for all outcomes, and comorbid medical conditions, lower estimated premorbid functioning, neurocognitive impairment, and nadir CD4 count for selected outcomes.

Conclusion: Findings suggest that older age may exacerbate the adverse effects of HIV on daily functioning, which highlights the importance of evaluating and monitoring the functional status of older HIV-infected adults. Early detection of functional difficulties could facilitate delivery of compensatory strategies (eg, cognitive remediation) or assistive services.

*Department of Psychiatry, University of California, San Diego, CA

Departments of Psychology and Psychiatry, San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA

Department of Neurosciences, University of California, San Diego, CA

§Research and Psychology Services, VA San Diego Healthcare System, San Diego, CA.

Correspondence to: Steven P. Woods, PsyD, Department of Psychiatry (8231), University of California, San Diego, 220 Dickinson St, Suite B, San Diego, CA 92103 (e-mail:

Dr. Erin Morgan receives ongoing research support from NIH T32 AA013525. Dr. Jennifer Iudicello receives ongoing research support from NIH T32 DA31098. Erica Weber receives ongoing research support from NIH T32 DA31098. Nichole Duarte receives ongoing research support from NIH Grants MH73419, P50 DA26306, MH62512, and MH59745. P. Katie Riggs receives ongoing research support from NIH Grants R01 MH92225, P30 MH62512. Dr. Lisa Delano-Wood receives ongoing research support from New Investigator Research Grant (Alzheimer's Association) 09 134067, National Institute of Aging (NIA) 5 R01 AG012674 14, Congressionally Directed Medical Research Programs (CFMRP)/Department of Defense (DoD) (two Awards: Delano-Wood, Principal Investigator, and Jak, Principal Investigator), NIH R01 MH083969 01A2, and NIH R01 MH73419. Dr. Ronald Ellis received consultant fees from NeurogesX and is funded by NIH grants R01 MH058076, U01 MH83506, P30 MH62512, R01 MH83552, P50 DA26306, R01 MH095621, U01 NS32228. Dr. Grant receives ongoing research support from NIH Grants P30 MH62512, P50 DA26306, P01 DA12065, N01 MH22005, U01 MH83506, R01 MH78748, R01 AG15301, R01 MH83552, and NIH/University of Nebraska P01 DA026146. He has also received honoraria from Abbott Pharmaceuticals as part of their Educational Speaker Program. Dr. Woods receives ongoing research support from NIH Grants P30 MH62512, P50 DA26306, R01 MH73419, T32 DA31098, and R01 MH084794. This research was supported by NIH Grants R01 MH73419 and T32 DA31098 to Dr. Woods, P30 MH62512 (I. Grant, Principal Investigator) and T32 AA013525 (E. Riley, Principal Investigator).

The authors have no other conflicts of interest to disclose.

Received February 23, 2012

Accepted July 26, 2012

© 2012 Lippincott Williams & Wilkins, Inc.