Clinical and Sociodemographic Characteristics Associated with Poor Self-Rated Health Among Older Adults Living with HIV

CLINICAL AND SOCIODEMOGRAPHIC CHARACTERISTICS ASSOCIATED WITH POOR SELF-RATED HEALTH ACROSS MULTIPLE DOMAINS AMONG OLDER ADULTS LIVING WITH HIV Duncan Short,1Frank Spinelli,2Chinyere Okoli,1Patricia de los Rios3 1ViiV Healthcare, Brentford, Middlesex, UK; 2ViiV Healthcare, Research Triangle Park, NC, USA; 3ViiV Healthcare Canada, Laval, QC, Canada 23rd International AIDS Conference; July 6-10, 2020; Virtual

Beyond Viral Suppression: Going Full 360 UNAIDS Targets Diagnosis: 90% of those with HIV will know their status1 Treatment: 90% of those diagnosed will be on treatment1 Viral suppression: 90% of those on treatment will be virally suppressed1 Quality of life: 90% of PLHIV will enjoy good health-related quality of life2 Overall Health Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity World Health Organization3 1. UNAIDS. https://www.unaids.org/en/resources/documents/2017/90-90-90. Accessed June 12, 2020. 2. Lazarus et al. BMC Med. 2016;14:94. 3. World Health Organization. https://www.who.int/about/who-we-are/constitution. Accessed June 12, 2020. 23rd International AIDS Conference; July 6-10, 2020; Virtual Short et al. AIDS 2020; Virtual. Slides OAD0903. 2

Overall Health and Subdomains Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity1 Image result for who logo MENTAL HEALTH Your state of well-being in which you realize your own potential, can cope with the normal stresses of life, can function productively and fruitfully, and are able to contribute to your community PHYSICAL HEALTH Physical condition of your body, specifically the absence of any illness or injury and being free from aches or pains in any part of your body MENTAL HEALTH PHYSICAL HEALTH OVERALL HEALTH SEXUAL HEALTH SEXUAL HEALTH Your sexual well-being, the quality of your sexual relations, your sex drive (libido), as well as your reproductive health and absence of any (non-HIV) sexually transmitted infections OVERALL HEALTH The totality of all health domains, including physical, mental, and sexual, as well their interactions with each other to influence health 1. World Health Organization. https://www.who.int/about/who-we-are/constitution. Accessed June 12, 2020. 23rd International AIDS Conference; July 6-10, 2020; Virtual Short et al. AIDS 2020; Virtual. Slides OAD0903. 3

Key Objectives What proportion of PLHIV aged 50 years report suboptimal health on each individual domain? What proportion of PLHIV aged 50 years report suboptimal health on all assessed domains? What are the clinical and demographic characteristics of those reporting suboptimal health on all domains? 23rd International AIDS Conference; July 6-10, 2020; Virtual Short et al. AIDS 2020; Virtual. Slides OAD0903. 4

Overview of Positive Perspectives Study Design Positive Perspectives is a multinational, cross-sectional, web-based survey for PLHIV collected between April and August 2019 Purpose: To understand the health of older PLHIV reporting suboptimal health on multiple domains Patient population in analysis: 699 participants aged 50 years (of 2389 total adults aged 18 years with confirmed HIV status and receiving antiretroviral treatment) From 25 countries that together account for 33.1% (12.53 million) of the global HIV burden Self-rated health assessment: Across 4 health domains (physical, mental, sexual, and overall) Scored as optimal ( Very good or Good ) or suboptimal ( Neither good nor poor, Poor, or Very poor ) Measured for associations between health domains and clinical/demographic characteristics using multinomial logistic regression, adjusting for gender and disease duration 23rd International AIDS Conference; July 6-10, 2020; Virtual Short et al. AIDS 2020; Virtual. Slides OAD0903. 5

PLHIV Aged 50 y in Selected Countries Relative to Total Sample Mean age among people aged 50 years, by region: North America, 59 y; Europe, 56 y; Latin America, 56 y; Asia, 55 y; Australia, 59 y; South Africa, 54 y Percentages of females aged 50 years by region: North America, 25%; Europe, 33%; Latin America, 26%; Asia, 32%; Australia, 14%; South Africa, 65% 23rd International AIDS Conference; July 6-10, 2020; Virtual 6

Self-Reported Suboptimal Health Prevalence 100 90 80 70 Percentage, % 60.5 60 46.1 50 44.1 38.2 40 30 20 10 0 Suboptimal sexual health Suboptimal physical health Suboptimal status, by domain Suboptimal mental health Suboptimal overall health Sexual health was the domain where the highest percentage reported suboptimal status, among 3 in 5 older adults overall 23rd International AIDS Conference; July 6-10, 2020; Virtual Short et al. AIDS 2020; Virtual. Slides OAD0903. 7

Correlation Between the Different Domains of Self-Rated Health 5 The subdomains with the strongest correlation with overall health were Physical health (Spearman s correlation, = 0.75) Mental health ( = 0.68) 0.75 0.68 0.51 4 Overall health 0.39 0.42 3 Sexual health 0.52 Mental health 2 1 Physical health 0 0 1 2 3 4 5 Overall health Physical health Mental health Sexual health 23rd International AIDS Conference; July 6-10, 2020; Virtual Short et al. AIDS 2020; Virtual. Slides OAD0903. 8

Self-Reported Suboptimal Health Prevalence by Domain and Region North America (N =146) 49% Suboptimal overall health Suboptimal mental health Suboptimal sexual health Suboptimal physical health 44% 36% 36% 63% 62% South Africa had the lowest percentage of reported suboptimal health in all domains. This gap narrowed after adjusting for age and sex, but some remained, suggesting the effect of other factors 51% 43% Europe (N = 357) 51% Suboptimal overall health Suboptimal mental health Suboptimal sexual health Suboptimal physical health 45% 42% 38% 64% 60% 47% 42% Latin America (N = 50) 28% 24% Suboptimal overall health Suboptimal mental health Suboptimal sexual health Suboptimal physical health 44% 34% 54% 54% 24% 43% Asia (N = 50) 52% 52% Suboptimal overall health Suboptimal mental health Suboptimal sexual health Suboptimal physical health 47% 41% 58% 58% 62% 46% Australia (N = 65) 32% 31% Suboptimal overall health Suboptimal mental health Suboptimal sexual health Suboptimal physical health 37% 32% 51% 55% 34% 36% South Africa (N = 31) 19% 16% Suboptimal overall health Suboptimal mental health Suboptimal sexual health Suboptimal physical health 32% 22% 39% 45% 10% 31% Unadjusted Age and sex-adjusted 23rd International AIDS Conference; July 6-10, 2020; Virtual Short et al. AIDS 2020; Virtual. Slides OAD0903. 9

Number of Domains on Which Suboptimal Health Was Reported, Overall and by Region 100 12% 14% 16% 90 21% 23% 26% 29% 8% 6% 80 14% 12% 70 17% 22% 11% 23% Percentage, % 15% 26% 60 12% 34% 50 12% 14% 29% 10% 40 23% 0 1 2 3 4 21% 21% 30 18% 55% 20 34% 32% 26% 23% 22% 10 20% 0 Total (N = 699) South Africa (N = 31) Latin America (N = 50) Australia (N = 65) Europe (N = 357) North America (N =146) Asia (N = 50) Overall, 26% reported optimal health on all domains, while 23% reported suboptimal health on all domains. Half the population was centered around these 2 extremes 23rd International AIDS Conference; July 6-10, 2020; Virtual Short et al. AIDS 2020; Virtual. Slides OAD0903. 10

Comparisons of Individuals Reporting Suboptimal Health on All 4 Domains vs Those Not Reporting Suboptimal Health on Any Domain PAST MAJOR DDI Yes vs no PAST ART RESISTANCE Yes vs no ART SIDE EFFECTS GI vs none Non-GI-only vs none POLYPHARMACY Yes vs no CO-MORBIDITIES One only vs. none Two+ vs. none CO-INFECTIONS Yes vs. no SUBSTANCE USE Yes vs. no STIGMA Anticipated stigma vs. none Internalized stigma vs. none Both forms of stigma DAYS MISSED ART/PAST MO 1 only vs. none 2-4 only vs none 5+ vs. none EDUCATION high school vs. < high school RACE White vs. nonwhite TREATMENT PERCEPTION Dissatisfied vs. satisfied 0 5 10 15 20 25 Adjusted odds ratios Groups most likely to report suboptimal health in all 4 domains included those with 2+ comorbidities, with suboptimal adherence, or those dissatisfied with treatment 23rd International AIDS Conference; July 6-10, 2020; Virtual Short et al. AIDS 2020; Virtual. Slides OAD0903. 11

Conclusions Of older adults living with HIV, 23% reported suboptimal health and 26% reported optimal health on all domains. Approximately half the population reported results within these 2 extremes. Geographic disparities exist in self-reported health status. These differences highlight the need for tailoring treatment to narrow inequalities. Groups with worst perceived health included those reporting 2 comorbidities, suboptimal adherence, and those dissatisfied with treatment. Holistic approach to care requires seeking improvements in all aspects of health and considering patients as a whole. Quality communication is needed to alleviate mental distress, which may not be readily discernable to HCPs. 23rd International AIDS Conference; July 6-10, 2020; Virtual Short et al. AIDS 2020; Virtual. Slides OAD0903. 12