Poor sleep is associated with negative health outcomes including decline in physical performance, reduced cognitive function and increased mortality risk. We set out to examine sleep quality among older adults living with HIV and identify factors associated with poor sleep.

We performed a cross-sectional analysis of the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study baseline data, a Canadian cohort of people living with HIV age 65 and older. The Pittsburgh Sleep Quality Index (PSQI) was used, with scores of >5 indicating poor sleep quality. Sleep quality was assessed according to demographic (age, sex, race), HIV-specific (duration of infection, nadir and current CD4 count) and clinical factors (number of comorbidities, depression diagnosis, cognitive function [Mini-Mental State Examination]), and by self-assessed wellbeing (Stanford Health Assessment Questionnaire scored 0-100 with 0 representing best sense of wellbeing) and health-related quality of life (HR-QoL) (Questionnaire on Life Satisfaction scored 0-100 with 100 representing optimal HR-QoL) using χ2 and Wilcoxon rank-sum tests.

The analysis included 233 participants (91% male) with a median [IQR] age of 71 [69,74] years. Half of participants (52%) reported poor sleep quality. Sleep quality did not differ according to age, sex, race or any HIV-specific factors examined. Participants reporting poor sleep had more comorbidities (median 3 vs. 2, p<0.001) and higher prevalence of depression (26% vs. 13%, p=0.013) than those with good sleep quality, but cognitive function scores did not differ between groups. Those reporting poor sleep had worse self-assessed wellbeing (median score 25 vs. 5, p<0.001) and and poorer HR-QoL (median score 72 vs. 81, p<0.001) than those reporting good sleep.

Poor sleep quality is common among older adults living with HIV and is associated with comorbidity and depression. Improving sleep quality in this population may contribute to a better sense of wellbeing and enhanced quality of life.

Objectives: Disability and physical activity are dynamic, interconnected processes that evolve over the life course. This study aimed to examine the interrelationships between disability and physical activity trajectories among adults aging with HIV.
Methods: We analyzed longitudinal data from adults enrolled in the Ontario HIV Treatment Network Cohort Study (OCS) who had between one to four annual disability and physical activity assessments from 2020–2023. Disability was measured using the short-form World Health Organization Disability Assessment Schedule (WHODAS 2.0; range=0–48, higher scores indicating greater disability severity). Physical activity was measured as the number of days engaged 30 or more minutes of moderate or vigorous physical activity in the last week. We performed group-based dual-trajectory modeling to estimate disability and physical activity trajectories simultaneously. We examined the linkage between trajectories using conditional and joint probabilities.
Results: In 2020, 76% of 1,709 participants were men and 59% were White; the mean age was 52.2 years (standard deviation: ±12.1). We identified four disability trajectories— no disability (36.2%), low disability (39.3%), medium disability (18.0%), and high disability (6.6%) – and four physical activity trajectories— barely active (17.2%), decreasing activity (16.3%), increasing activity (21.2%), and highly active (45.3%). We observed within- and between-person variability across all trajectories. Sixty-three percent of participants in the no disability trajectory were in the highly active trajectory, whereas 64.5% of the high disability trajectory were in the barely active or decreasing physical activity trajectories. The most frequent combinations were no disability plus highly active (22.1%) and low disability plus highly active (17.1%).
Conclusion: Disability and physical activity were each characterized by four distinct trajectories over four years among adults aging with HIV. Our results highlight the intertwined nature between disability and physical activity over time. Further work is needed to identify common factors or mechanisms underlying these trajectories.

Background: HIV infection is associated with chronic immune activation resulting in the development of chronic inflammatory diseases, a.k.a. non-communicable diseases (NCDs). NCDs such as heart disease, diabetes, and hypertension disproportionately affect Black populations compared to non-Black populations. We thus investigated the plasma proteomic levels in the two populations.

Methods: Using a proteomic plasma profiling approach comprising 92 inflammation-related molecules, we initially examined protein levels in HIV-1-negative (PLWoH, n=12) and HIV-1-positive individuals (PLWH, n=20). Subsequently, levels of proteins were compared between age/sex-matched HIV-1-positive Black (n=10) and non-Black (n=10) patients. Significantly expressed proteomes were analyzed using Enrichr, for Gene Ontology (GO), Kyoto Encyclopedia Genes and Genomes (KEGG), Reactomes and STRING protein-protein interactions.

Results: Assessment of proteomics expression levels in PLWH compared to PLWoH, or Black PLWH compared to non-Black PLWH revealed distinct clustering patterns. Whereas the expressions of CXCL11, CCL20, CXCL1, CXCL10, SLAMP1, CSF1, PDL1, OPG, ADA, CD8A, IL18R1, MMP10, and CD6 were significantly elevated, the expression of 4E-BP1 and TRANCE was reduced considerably in PLWH compared to PLWoH. Interestingly, we observed differential expression of protein levels when PLWH were stratified by race. Whereas CXCL11, CXCL5, DNER, TRAIL, TRANCE, and SCF expression levels were significantly increased, the protein levels of OSM, CXCL9, TNFSF14, MCP-1, TGF-α, and HGF were significantly decreased in Black PLWH compared to non-Black PLWH. GO enrichment and protein-protein interaction analysis revealed a positive regulation of inflammatory responses, and significant enrichment of the chemokine-, cytokine-, and innate-signaling pathways.

Conclusions: These findings highlight the importance of considering racial differences in proteomic markers when assessing disease risk. Understanding these distinctions underscores the importance of personalized medicine for developing targeted prevention and treatment strategies for chronic inflammation conditions among PLWH.

Introduction: People living with HIV (PLWH) often experience premature physical deficits such as difficulties with walking, mobility, balance, and dual-tasking. These deficits may contribute to a reduced quality of life, increased fall risk, and diminished independence.
Objectives: The purpose of this systematic review and meta-analysis was to estimate the extent to which deficits in gait speed, mobility, balance, and dual-tasking are present in PLWH. Our secondary objective was to make recommendations regarding the use of rehabilitation outcome measures.
Methods: Searches were conducted in CINAHL, PUBMED, and SPORTDiscus databases. Two independent reviewers screened titles, abstracts, and full-text articles, extracted data, and assessed the methodological quality of included studies using the National Institutes of Health Quality Assessment Tool.
Results: A total of 56 studies, comprising 14,053 PLWH and 8,454 uninfected controls, met the inclusion criteria. Meta-analysis revealed that PLWH performed significantly worse than controls on the Five Times Sit-to-Stand test, a measure of lower-body strength and mobility (Cohen’s d = 0.68, 95% CI [0.08, 1.29], p = .03). However, no significant differences were observed for usual gait speed (Cohen’s d = -0.47, 95% CI [-1.10, 0.15], p = .14) or fast gait speed (Cohen’s d = -0.39, 95% CI [-0.87, 0.08], p = .10). Balance outcomes were assessed in 12 studies, 10 of which found significant deficits among PLWH compared to controls.
Conclusion: Our findings highlight the need for targeted rehabilitation interventions to address mobility and balance deficits in PLWH. Routine assessment of functional outcomes, such as the Five Times Sit-to-Stand test and more challenging balance assessments such as the Community Balance and Mobility Scale, single leg stance test, or bilateral stance on foam with eyes closed should be integrated into clinical care to guide individualized rehabilitation strategies. PLWH with walking, mobility, and balance problems should be referred to rehabilitation professionals.

Background
Life expectancy (LE) among people living with HIV (PLWH) in British Columbia (BC) has increased over time, but remains lower among females with an increasing sex-gap. We assessed sex-differences in age-related chronic disease-free LE among PLWH in BC.

Methods
We used linked administrative data on virtually all known PLWH in BC (1996-2020) to calculate LE at ages 20, 40, and 55 using life tables stratified by sex and calendar period (1996-2001, 2002-2011, 2012-2020). Mid-period prevalence of cardiovascular, chronic kidney, liver, chronic obstructive pulmonary, and Alzheimer’s disease, and of diabetes mellitus, osteoarthritis, osteoporosis, and cancer was assessed, using a 5-year look-back window, published case-finding definitions and the cancer registry, to calculate chronic disease-free LE.

Results
Among 2,511 females and 11,624 males with HIV, chronic disease-free LE increased between time-periods 1996-2001 and 2012-2020 at age 20, 40, and 55, but remained lower among females (Figure 1). However, years spent with ≥1 chronic condition also increased over time among both males and females: among males aged 20 from 2.06 (95% CI: 1.88-2.24) in 1996-2001 to 6.57 (6.20-6.94) in 2012-2020 and aged 55 from 2.58 (2.12-3.05) to 6.01 (5.56-6.45); among females aged 20 from 2.32 (1.91-2.73) to 5.63 (4.90-6.36) and aged 55 from 1.53 (0.44-2.60) to 5.26 (4.11-6.41).

Conclusion
Our preliminary findings show that while age-related chronic disease-free LE increased over time among PLWH in BC, so did time spent with ≥1 chronic condition. Whereas chronic disease-free LE was consistently lower among females, time spent with chronic disease was similar for both sexes.

Background: Advancements in antiretroviral therapies have extended the life expectancy of persons living with HIV (PLWH), creating a new paradigm of aging with the virus. As this population enters later life, many encounters unique challenges in maintaining independence and may need additional support services. Our study explores the beliefs, attitudes and knowledge of older PLWH regarding the spectrum of continuing care options ranging from home care to long-term care facility living in Alberta.

Design: Using a purposive sampling approach, we conducted semi-structured interviews with PLWH aged ≥50 years between January to August 2024. Participants were invited from a sample of older adults who participated in a confidential online survey on continuing care and expressed interest in being a part of the interview. Participants were invited to ensure a diverse representation of backgrounds and perspectives.

Setting: The Southern Alberta Clinic (SAC) in Calgary, Alberta, Canada

Participants: A cohort of PLWH ≥50 years, receiving comprehensive HIV-care at the Southern Alberta Clinic (SAC).

Results: Thematic analysis of interviews with 25 participants, representing a diverse spectrum of gender, race, age in Southern Alberta, unveiled five crucial themes: 1) Fear of continuous HIV-stigma across continuing care settings; 2) Financial burdens regarding continuing care; 3) Concerns about diminishing autonomy; 4) Complexities of HIV-status disclosure 5) Lack of education for patients on continuing care supports.

Discussion/ Conclusion: These findings illuminate lived experiences of aging, HIV, and continuing care perceptions. Strategies are needed to assist older persons living with HIV in navigating care supports while also preserving independence. Tools and interventions should prioritize education, HIV-stigma reduction, and the development of inclusive aging care frameworks that honor the multifaceted identities for those with lived experiences.