María José Fuster-RuizdeApodaca

Introduction: Individuals aging with HIV face significant challenges that can negatively impact their long-term health, including biomedical complications, premature aging, and the influential role of aging-related stereotypes. Our study aimed to investigate whether a more positive self-perception of aging is associated with better health-related quality of life and less adverse impacts of premature aging on people living with HIV. Methods: We conducted a multicenter study combining a cross-sectional survey with a 2-year retrospective extraction of clinical data from medical records, involving 285 participants aged ≥ 50 years (77.9% male) living with HIV in Spain. Participants reported their health-related quality of life, self-perception of aging, and cultural age-related stereotypes. Additionally, two years of retrospective clinical health data were collected for eight areas: Metabolic, Neurological, Neoplastic, Bone, Hepatic, Renal, Cardiovascular, and Others. Results: As expected, worse physical health over the past two years had a negative impact on the self-perception of aging. Cultural age-related stereotypes of warmth and competence were found to predict their internalization into the self-concept. However, only self-perceived competence mediated the influence of the cultural age-related stereotype of the competence dimension on a more positive self-perception of aging. Furthermore, a positive self-perception of aging positively predicts all dimensions of health-related quality of life. Conclusions: Our data suggest two interrelated pathways that may influence the aging process: a clinical pathway, characterized by the negative impact of pre-existing comorbidities, and a psychosocial pathway, related to the internalization of cultural stereotypes. This study highlights the impact of cultural stereotypes on the self-perception of aging through their internalization in a sample of individuals experiencing premature aging.

HIV-related stigma remains a persistent barrier to the well-being of people with HIV. Drawing on Moral Foundations Theory, we conducted two studies in Spain to explore how individualizing (particularly care) and binding (particularly purity) foundations contribute to HIV-related stigma, and whether this relationship is mediated by the moralization of HIV. In Study 1, binding foundations were associated with higher levels of HIV moralization and HIV-related stigma, while individualizing foundations predicted lower levels of both. In Study 2, we contrasted care- versus purity-based moral framing and assessed the moralization of HIV and several measures of HIV-related stigma, as in Study 1. Participants exposed to messages emphasizing the social benefits of purity (vs. care) were more likely to moralize HIV and express negative attitudes toward people with HIV; however, neither framing condition differed from the control condition. Moreover, indirect effects indicated that purity framing may heighten HIV-related stigma through increased moralization of HIV. These findings suggest that moral concerns - particularly purity - contribute to HIV-related stigma by imbuing HIV with moral significance. We discuss the implications for HIV stigma-reduction strategies.

Our aim was to evaluate long-term health-related quality of life (HRQoL) in 253 people living with HIV (PLH) from the CoRIS cohort presenting to care with advanced HIV disease (AIDS or CD4 ≤ 100 cells/µL) and who had survived ≥ 5 years. Participants completed the WHOQOL-HIV-BREF and EQ-5D-5 L questionnaires. Clinical and immunological data were provided by the CoRIS at enrollment and on questionnaire completion. Linear repeated measures analyses assessed the evolution of immunological markers. Partial least squares structural equation modeling showed the longitudinal impact of baseline immunological markers on HRQoL. High baseline CD4 counts predicted higher WHOQOL-HIV-BREF independence scores (p = 0.021) and a marginally higher EQ-5D-5 L index value (p = 0.058), which was also associated with CD8 (p = 0.015). A higher CD4/CD8 ratio predicted lower scores on the WHOQOL-HIV-BREF ‘spirituality, religion and personal belief’ dimension (p = 0.006). Currently, PLH who present with advanced HIV disease achieve a moderate long-term HRQoL, with room for improvement.

Objectives: The objective is to assess the interconnectedness of a network of health‐related quality of life (HRQoL) variables among people with HIV (PHIV) to identify key areas for which clinical interventions could improve HRQoL for this population.Methods: Between 2021 and 2023, we carried out a cross‐sectional study within the Spanish CoRIS cohort. We conducted a weighted and undirected network analysis, which examines complex patterns of relationships and interconnections between variables, to assess a network of eight HRQoL dimensions from the validated Clinic Screening Tool for HIV (CST‐HIV): anticipated stigma, psychological distress, sexuality, social support, material deprivation, sleep and fatigue, cognitive problems and physical symptoms.Results: A total of 347 participants, predominantly male (93.1%), currently working (79.0%), self‐reported homosexual (72.6%) and college‐educated (53.9%), were included in the study. Psychological distress showed the highest centrality in the network, indicating its strong connections with sleep and fatigue, cognitive problems and social support within the HRQoL network.Conclusions: Psychological distress, sleep and fatigue, cognitive issues and social support were identified as key factors in an HRQoL network, indicating that interventions focused on these areas could significantly enhance overall well‐being.

Spain was close to meeting the 90-90-90-treatment target set by UNAIDS. However, data on health care quality regarding people with HIV and their health-related quality of life (HRQoL) after the COVID-19 pandemic onset is scarce. By considering the perspective of people with HIV and HIV specialists, we aimed to determine some aspects of the quality of care in Spain, such as access to health resources or satisfaction with primary and speciality care, and assess people with HIV health-related quality of life. Ex post facto cross-sectional surveys were administered to 502 people with HIV and 101 HIV clinicians. Unmet needs related to healthcare system and healthcare resources access and to antiretroviral treatment administered by hospital pharmacies were detected. There was also room for improvement in the primary care service delivery and in various aspects concerning people's with HIV HRQoL. About one-fourth of them experienced stigmatisation in the healthcare setting, which was significantly related to HRQoL. Women, heterosexual participants and those with problems accessing the healthcare system scored poorer in the HRQoL scales. Moreover, according to our data, HIV specialists did not seem to be fully aware of patients' with HIV needs and overestimated their HRQoL.

The purpose of the study was to assess the effects of advanced HIV disease (AHD) on health-related quality of life (HRQoL) in PLHIV, the changes in HRQoL outcomes over the last 25 years, and the differences between countries according to level of economic development. We conducted a systematic review and meta-analysis. The search was conducted in PubMed and Web of Science using the terms: “health-related quality of life”, “HQRoL”, “HIV”, “AIDS”, “advanced HIV disease” and “low CD4 cells”. Studies inclusion criteria were: adult population; initiated after 1996 and published before July 2021; clinical trials, cross-sectional, cohort, and case–control studies; studies analyzing the relationship between AHD and HRQoL; English or Spanish language. Standardized mean differences (d+) were calculated to estimate the effect size for the meta-analyses. Summary statistics were calculated using a random-effects model, and analyses of effect moderators, using mixed-effects models. The meta-analysis included 38 studies. The results indicated that HRQoL is worse in patients with AHD compared to those without. The main HRQoL domains affected were overall health perception and concern and physical and functional health and symptoms. We found a moderate impact for age and gender on some HRQoL domains. There were no differences in relation to socioeconomic inequities, country of residence, or time period analyzed. In conclusion, advanced HIV disease has a negative impact on health and well-being in PLHIV. Our results show that despite all the advances in antiretroviral treatments over the last 25 years, AHD persists as a source of extreme vulnerability, regardless of where PLHIV live.

Purpose: This study aims to assess the impact of a peer intervention programme in the hospital setting to improve the health-related quality of life (HRQoL) of people recently diagnosed with HIV infection. Methods: A quasi-experimental single-group study with pre- and post-measurements was conducted. The peer intervention programme consisted of four sessions that took place at the following times: (1) the day of diagnosis, (2) the day when the results of the analyses were collected and ART (antiretroviral therapy) began, (3) one month after the start of ART, and (4) four months after the start of ART. The dependent variables were HRQoL and several of its psychological predictors. Change in the dependent variables was analysed through repeated measures, variance analysis and covariance analysis. Forty-three people with HIV participated in the intervention (40 men, mean age = 39.14). Results: A significant positive evolution was found in all the predictors of HRQoL, except avoidant coping (p < .05). A positive evolution was also found in all HRQoL dimensions (p < .05). There was a significant increase in CD4 cells/mm³ lymphocytes (p < .0001) and in the CD4/CD8 ratio (p < .001). The positive differential scores in the psychological health and social relationship dimensions influenced the increase in CD4 cells/mm³ lymphocytes (p = .012, p = .13). The increase in the social relations dimension score and overall health perception influenced the recovery of the CD4/CD8 ratio (p = .044; p = .068). Conclusions: Peer intervention improved the HRQoL of people recently diagnosed with HIV, and enhanced psychological health and social relationships covariate with their immunological recovery. This study represents an essential advance in evaluating peer intervention programmes for positive prevention.

Objectives: In recent decades, the needs of people living with HIV have evolved as life expectancy has greatly improved. Now, a new definition of long‐term success (LTS) is necessary to help address the multifaceted needs of all people living with HIV.Methods: We conducted a two‐phase research programme to delineate the range of experiences of people living with HIV. The insights garnered from these research phases were explored in a series of expert‐led workshops, which led to the development and refinement of the LTS framework.Results: The insights generated from the research phases identified a series of themes that form a part of LTS. These themes were subsequently incorporated into the LTS framework, which includes five outcome pillars: sustained undetectable viral load, minimal impact of treatment and clinical monitoring, optimized health‐related quality of life, lifelong integration of healthcare, and freedom from stigma and discrimination. A series of supporting statements were also developed by the expert panel to help in the achievement of each of the LTS pillars.Conclusions: The LTS framework offers a comprehensive and person‐centric approach that, if achieved, could help improve the long‐term well‐being of people living with HIV and support the LTS vision of ‘every person living with HIV being able to live their best life’.

Over the past few decades, the life expectancy of people living with HIV has markedly improved due to the advances in HIV diagnosis, linkage to care, and treatment. However, with these advances, a new set of challenges has emerged that must be addressed to ensure the long‐term well‐being of people living with HIV. In this article, as part of a wider journal supplement, we explore the unmet needs and challenges across the HIV continuum of care and re‐define what long‐term success looks like to support the healthy ageing of all people affected by HIV.

Introduction: The World Health Organization's (WHO's) new global health strategy on HIV represents a major step toward a broader conceptualization of HIV care. It recognizes the importance of addressing chronic care more fully and–for the first time ever–the health‐related quality of life (HRQoL) of people living with HIV (PLHIV).Methods: A thorough literature review was conducted in order to analyse how the WHO strategy on HIV for 2022‐2030 addresses the monitoring of the HRQoL of PLHIV for the next decade and compared it to that of other countries and health authorities.Results: Unlike for other issues, the strategy does not include quantitative targets for 2030, thus falling short of committing to monitoring global progress in improving the long‐term well‐being of PLHIV.Conclusions: We urge national health systems not to wait for WHO to lead on this issue. Seeking good HRQoL outcomes for PLHIV can confer far‐reaching benefits on health systems. The feasibility of monitoring population‐level HRQoL has been demonstrated through the use of simple tools like patient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs). Many countries can already set HRQoL monitoring targets, similar to those presented in this viewpoint, while we work toward an agreed minimum metric for use by all countries.