Amsterdam 2015
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| Abstract #2304 - "When I am 64" - Ageing and HIV | ||||
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Session: 51.4: "When I am 64" - Ageing and HIV (Parallel) on Friday @ 11.00-12.30 in C104 Chaired by Sarah Zetler, Mylene Fernet Authors: Presenting Author: Dr. Luis Sagaon Teyssier - UMR912 SESSTIM/ORS-PACA, France |
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| Additional Authors: | ||||
| Aim: Although psychosocial and behavioral outcomes among people living with HIV (PLWH) are widely studied and associated factors well known, the potentially confounding relationship between age and cohort membership (defined by year of HIV diagnosis) is less understood. ANRS-VESPA2 survey analysis showed the respectively negative and positive association of age with physical and mental quality of life (QoL). Time since HIV diagnosis was negatively associated with both dimensions. Collinearity between age and cohort membership effects may result in large biases, impairing their individual understanding. This study aimed to assess to what degree variations in psychosocial and behavioral outcomes among PLWH can be attributed to cohort effects, age and combination of both factors, using a tailored methodological framework. | ||||
| Method / Issue: ANRS-VESPA2 is a cross-sectional survey conducted in 2011 on 3,022 adult PLWH attending French hospitals and HIV-diagnosed >6 months. Socio-behavioural (face-to-face interviews) and medical (provided by professionals) data were collected. Outcomes were the need for moral and material support, mental and physical QoL (SF-12), and disclosure to at least one relative, friend or colleague. A semi-parametric Generalized Additive Model was used to non-parametrically estimate the effects of age and cohort membership (defined year of HIV diagnosis). Other factors were controlled for parametrically. | ||||
| Results / Comments: Empirical degrees of freedom (EDF) helped describe the non-parametric relationship between outcomes and age and/or cohort membership, and its linearity (EDF=1) or not (EDF>1). Cohort membership effects were absent for both moral and material need for support, whereas there was a significant non-linear relationship between these outcomes and age (EDF=8.6, p<0.001 and 7.7, p<0.001 respectively). Non-linearities revealed that with increasing age the need for both moral and material support decreased until 60 years of age, then increased, for material support, at a more accentuated pace, irrespective of the year of HIV diagnosis. The physical QoL dimension showed overall positive non-linear relationship with cohort effects (EDF=3.1, p<0.05), combined with a negative linear age effect (EDF=1.1, p<0.001). For the mental QoL dimension, both effects were non-linear (Cohort-EDF=2.2, p<0.001 age-EDF=6.2, p<0.001): overall positive relationship with cohort and decreasing for youngest and oldest patients. Disclosure was associated with non-linear cohort effects (EDF=3.8, p<0.001) combined with a negative linear age effect (EDF=1, p<0.001). | ||||
| Discussion: Results highlighted the importance of disentangling age from cohort effects to understand the interaction of developmental and contextual influences on the evolution of psychosocial and behavioral outcomes among PLWH. Idiosyncratic psychological reactions, with respect to a moral and material need for support, seem to be individual processes represented exclusively by age differences. QoL processes are linked to combined effects of cohort and age. Estimations suggest that physical QoL is mostly influenced by cohort effects perhaps from exposure to different clinical contexts over time. Moreover, mental QoL appears to be an individual process mostly evolving with age. Reactions to HIV disclosure reflect combined age and cohort effects. Understanding these processes should help when constructing policies focusing on different HIV generations (defined by year of diagnosis) and/or age groups, according to the psychosocial and/or behavioral aspect to be improved in the life of PLWH’s lives. | ||||
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