COMBINED EFFECTS OF AGE AND HIV DISEASE ON CHANGES IN EVERYDAY FUNCTIONING OVER ONE YEAR

Introduction: Although HIV disease has evolved into a manageable condition with increased life expectancy, HIV-associated neurocognitive disorders (HAND) still persist in roughly 30-50% of people with HIV (PWH). As the HIV population lives longer, it is imperative to understand how aging impacts the expression and trajectory of the daily impact of HAND. The current study examined the combined effects of age and HIV disease on change in everyday functioning over one year and investigated the mediating role of changes in neurocognition. Methods: This observational, retrospective study employed a repeated measures factorial design. A total of 183 individuals with and without HIV were enrolled into younger (ages 18 to 40) and older groups (ages 50+). Participants completed a comprehensive neurocognitive evaluation and several assessments of everyday functioning at baseline and follow-up visits approximately 14 months apart. Study questions were analyzed using repeated measures MANOVAs, GLM mediation models, and cross-lagging panel models. Results: While cross-sectional age by HIV interactions were observed in the expected direction, these were tempered by a three-way interaction between age, HIV, and time for ADL declines such that older PWH exhibited steeper declines across 14-months. Change in neurocognition did not mediate the relationship between age and HIV status with everyday functional outcomes. Notably, baseline ADL declines predicted subsequent change in neurocognition at follow-up within the entire sample. Conclusions: Synergistic effects of aging and HIV disease were observed to accelerate functional declines over one year. Everyday functional declines may occur independently of, and prior to, neurocognitive changes, emphasizing the clinical relevance for accurate assessment and tracking of everyday functioning in older PWH.