Older Women With HIV Have Worse Physical Function, Quality of Life

In adults with HIV aged >50 years, women have worse physical function and lower quality of life, according to study results published in the Journal of Acquired Immune Deficiency Syndrome. The study highlighted that these results should be assessed against previous data that has demonstrated that women have better immunologic recovery, as measured by CD4 T-cell count and CD4/CD8 ratio, and lower rates of cardiovascular disease and cardiovascular risk factors than men.

In this prospective, cross-sectional study, researchers gathered data from a single-center study in Italy between June 15, 2016 and May 15, 2018 to evaluate differences between women and men with HIV aged >50 years in HIV variables, comorbidity, physical function, and quality of life (QoL). Gait speed and the Short Physical Performance Battery were used to measure physical performance. To measure QoL, researchers used the EQ5D5L and the presence and intensity of pain.

Of the 1126 older adults with HIV included in the study, women represented roughly a quarter of the total patients (n=284, 25.2%). The mean age was 56.7 years and 10.2% were aged >65 years.

Compared with men, women had a better immunologic recovery as measured by CD4⁺ T-cell count (median, 758 vs 699; P =.03) and a better CD4/CD8 ratio (median, 1.01 vs 0.83; P =.0001). In addition, women had a lower burden of comorbidity, which included alcohol consumption, cardiovascular disease, hypertension, diabetes, and renal failure (P =.0001 for all).

However, physical function and QoL were worse in women. Regarding lower extremity strength measured by the chair stand test, 10.5% of women took more than 13.70 seconds to complete the test compared with 5.5% of men (P =.005). Despite the fact that walking speed tended to be faster in women and sarcopenia tended to be more prevalent in men, the percentage of women with an Short Physical Performance Battery score <9 was double that of men (11.5% vs 5.6%; P =.002). Further, physical activity scores were significantly lower in women vs men (372.98 vs 509.54; P =.004).

Exhaustion (more than once a day per week) was more frequent in women than men (43.9% vs 31.1%; P =.001). Pain was more prevalent and severe in women than in men (62% vs 54.1%; P =.001) and EQ5D5L was significantly worse in women (0.87 vs 0.89; P =.02).

After adjusting the results by age, age at HIV diagnosis, years of known HIV duration, clinical category at HIV diagnosis, current CD4⁺ T-cell count, CD4/CD8 ratio, and cardiovascular disease, sex remained an independent predictor of physical performance, physical activity, and QoL.

Older women with HIV have special characteristics and specific needs that are different from men, and the assessment of physical function, pain, and QoL are crucial to helping women with HIV age well.

Reference

Brañas F, Sánchez-Conde M, Carli F, et al. Sex differences in people aging with HIV. J Acquir Immune Defic Syndr. 2020;83:284-291.