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  3rd International Workshop on HIV and Aging
November 5-6, 2012
Baltimore, MD
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HIV+ People Over 50 Have No More Depression or Anxiety Than Younger Adults
  3rd International Workshop on HIV and Aging, November 5-6, 2012, Baltimore

Mark Mascolini

HIV-positive people older than 50 had no more anxiety or depression than younger adults with HIV, according to results of a 15-country European/Canadian study [1]. Prevalence of neurocognitive impairment was marginally lower in the older people, while but physical health summary scores were significantly higher in younger people.

As growing numbers of HIV-positive people live into their 50s and beyond, data remain scant on how aging with HIV affects the psychological, neurocognitive, and other comorbid conditions that often come with older age. To address these questions, CRANIum study researchers in Western Europe and Canada conducted this comparison of adults older than and younger than 50.

CRANIum is a cross-sectional study that assesses several health variables in antiretroviral-naive and experienced adults at least 18 years old in 15 countries. Antiretroviral-treated people had to be taking a boosted protease inhibitor or a nonnucleoside for at least 9 months. No one had a history of stroke or active central nervous system opportunistic infections or malignancies, and no one used illegal substances or abused alcohol in the past 3 months. That last criterion would exclude injection drug users and many gay men.

Researchers used the Hospital Anxiety and Depression Scale to screen for anxiety (HADS-A) and depression (HADS-D), and they used the Brief Neurocognitive Screen (BNCS) to screen for neurocognitive impairment. A subset of cohort members completed the MOS-HIV questionnaire to assess quality of life [2].

The analysis included 2834 people, 683 of them (24%) older than 50. Most cohort members (61.5%) were men, with similar proportions in the under-50 and over-50 groups (60.9% and 63.4%, P = 0.24). Caucasians made up a lower proportion of younger people (76.6% versus 85.2%, P < 0.0001), and a higher proportion of younger people had not begun antiretroviral therapy (35.9% versus 17.3%, P < 0.0001). Average time since HIV diagnosis was significantly shorter in the younger group (87.2 versus 133.9 months, P < 0.0001).

Under-50 cohort members differed from the over-50 group in proportion married or in a civil partnership (22.6% versus 31.3%, P < 0.0001), proportion with children (34.9% versus 53.3%, P < 0.0001), proportion unemployed (27.5% versus 50.8%, P < 0.0001), and proportion with at least a secondary-school education (84.1% versus 75.3%, P < 0.0001).

Significantly fewer younger people had a previous psychiatric diagnosis (19.1% versus 23.9%, P = 0.01). But the under-50 contingent did not differ from the over-50 group in positive screens for depression, anxiety, or neurocognitive impairment. Indeed, there was a trend toward lower neurocognitive impairment prevalence in people older than 50:

-- Depression: 15.3% younger versus 17.0% older, P = 0.3

-- Anxiety: 34.1% younger versus 31.4% older, P = 0.21

-- Neurocognitive impairment: 42.1% younger versus 38.1% older P = 0.06

The trend to a lower rate of neurocognitive impairment in the older group did not reach statistical significance in antiretroviral-experienced people (43.1% younger versus 39.1% older, P = 0.1) or antiretroviral-naive people (40.3% versus 33.1%, P = 0.13). Nor did antiretroviral experience affects depression or anxiety results.

The MOS-HIV questionnaire indicated similar average mental health summary scores in younger and older cohort members (49.27 versus 48.78, P = 0.4). But the younger group had a higher (better) average physical health summary score (52.67 versus 48.87, P < 0.0001).

While cautioning that results must be interpreted in light of demographic and clinical differences between the two age groups, the researchers suggested their findings "support a strategy of regular screening for and clinical management of anxiety, depression and neurocognitive impairment for all HIV-infected patients."


1. Robertson K, Bayon C, Molina JM, et al. Neurocognitive impairment and anxiety/depression in HIV-1 infected patients across Western Europe and Canada: CRANIum study age analysis. 3rd International Workshop on HIV and Aging. November 5-6, 2012, Baltimore. Abstract O_02.

2. Wu AW. MOS-HIV Health Survey users manual.