Associations of loneliness with cognitive function and quality of life (QoL) among older adults living with HIV – 18% lonely quite often
Younger people with HIV more often lonely than their elders.
Many consider loneliness an affliction most common in the elderly, but a study of 836 HIV positive people in Canada found loneliness more likely in the youngest age group studied, those 35 to 45. 
Almost 1 in 5 people in the overall study group reported feeling lonely “quite often,” while almost half said they were “sometimes” lonely. HIV stigma, depression, and waning cognitive function can contribute to loneliness in people with HIV infection. A study of 914 HIV positive men and women over age 50 in New York City found that 39% had symptoms of major depression that could be predicted by increased loneliness, increased HIV-associated stigma, decreased cognitive functioning, reduced energy, and younger age. 
Loneliness predicts coronary heart disease and stroke in the general population. 
To get a better understanding of loneliness prevalence and predictors in middle-aged and older people with HIV, Canadian researchers analysed data collected at the first visit for Positive Brain Health Now, a longitudinal study of HIV positive people in care at 5 outpatient clinics. All participants were 35 or older and had HIV infection for at least one year. No one had dementia or a known central nervous system disorder.
The investigators determined loneliness prevalence by asking one question: Do you find yourself feeling lonely: quite often, sometimes, or almost never? They rated cognitive function on the B-CAM battery of cognitive tests and the PDQ perceived deficit questionnaire. The researchers used proportional odds regression and multiple linear regression to estimate the strength of associations between loneliness and other conditions after adjustment for age, sex, and education.
The 836 participants who enrolled between October 2013 and June 2016 were mostly (85%) men with an average age of 52 years (standard deviation 8.3). Almost three quarters of participants, 71%, were Caucasian. While 148 people (18%) felt lonely “quite often,” 383 (46%) “sometimes” felt lonely and the rest almost never felt lonely. These loneliness rates did not differ between women and men. But the study linked several factors to a higher likelihood of loneliness: insufficient funds (37.0% quite often lonely, 18.7% sometimes lonely, 7.3% never lonely, p <0.001), more HIV-specific symptoms (average 5.1, 4.6, 3.8, p <0.001), and lung disease (16.9%, 19.9%, 11.8%, p <0.05).
Average age was significantly younger in people who felt quite often lonely (51.2) or sometimes lonely (52.5) than in those never lonely (54.4) (p < 0.05). Compared with older people, those 35 to 45 proved significantly more likely to report loneliness (p < 0.05).
Statistical analysis identified several sociological and psychological factors that may contribute to loneliness: stigma (21.1% quite often lonely, 13.4% sometimes lonely, 6.0% never lonely, p <0.001), having fewer than 5 close people (71.0%, 51.2%, 29.9%, p <0.001), having no plans or goals (23.8%, 9.8%, 7.2%, p <0.001), not working or volunteering (34.5%, 31.1%, 22.9%, p <0.05), and SF-36 scores  for pain, vitality, and physical function.
Four lifestyle factors predicted loneliness: fewer hours of physical activity (average 7.0 quite often lonely, 8.1 sometimes lonely, 9.8 never lonely, p <0.001), seldom active (37.4%, 22.1%, 19.9%, p <0.001), more TV hours weekly (18.4, 15.4, 14.6, p <0.05), and opioid use independently of pain (14.6%, 10.4%, 5.4%, p <0.05). Current smoking did not differ significantly by loneliness status.
Compared with people who almost never felt lonely, those who felt lonely sometimes or quite often consistently had worse emotional and mental health outcomes including cognitive ability, stress, depression, anxiety, and outcomes reflecting self-rated health, health-related quality of life, and overall quality of life.
The researchers noted that results may not apply to everyone with HIV because the study group consisted largely of men and Caucasians. They also stressed that loneliness – a discrepancy between desired and actual level of socialisation – is not the same as isolation. That distinction could bear on the greater loneliness identified in younger people.
The investigators concluded that almost two thirds of these middle-aged and older adults felt lonely sometimes or quite often. They proposed that “interventions to engage people in socially meaningful activities, shown to be effective for loneliness in other conditions, should be developed for older adults living with HIV.”
- Harris M et al. Associations of loneliness with cognitive function and quality of life (QoL) among older adults living with HIV. 9th International Workshop on HIV and Aging, September 13-14, 2018, New York. Abstract 12.
- Grov C et al. Loneliness and HIV-related stigma explain depression among older HIV positive adults. AIDS Care. 2010;22:630-639.
- Valtorta NK et al. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102:1009-1016.
- RAND Health. 36-Item Short Form Survey (SF-36). https://www.rand.org/health/surveys_tools/mos/36-item-short-form.html