| Publication Abstract Display | | Type: Poster | | Title: Adverse and protective predictors of change in everyday functioning across two years in adults aging with HIV. | | Authors: Ham L, Franklin DR, Ellis RJ, Letendre S, Grant I, Moore DJ | | Date: 02-06-2026 | | Abstract:Objective:
People with HIV (PWH) now live comparable lifespans to the general U.S. population yet remain at increased risk for declines in cognition and everyday functioning. Alternatively, many PWH demonstrate resilience against HIV-related pathology, raising interest in positive psychological factors (PPFs) that may offset risks.
We build upon our previous work to 1) explore cognitive, behavioral, and physiological predictors of two-year everyday functioning decline in an independent longitudinal dataset of PWH, 2) compare the performance of our functional decline risk index to an existing mortality risk index, and 3) examine the incremental validity of adding PPFs to both indices.
Participants and Methods:
122 PWH (Mage=51, 84% male, 54% White) who completed neuropsychological testing, behavioral questionnaires, and routine labs (e.g., platelets) at baseline and two years were considered for analyses.
We developed a point-based prognostic risk index for functional decline in the CNS HIV Antiretroviral Therapy Effects Research study (i.e., CHARTER Index) incorporating the following variables: age, race, thrombocytopenia, motor skills, current depressive symptoms, lifetime major depressive disorder (MDD), chronic pulmonary disease, and employment. A cut-off of 23 indicated elevated risk for functional decline. Continuous CHARTER Index scores and dichotomized risk group (normal vs. elevated) were compared to the Veterans Aging Cohort Study (VACS) Index 1.0 and 2.0, a well-validated mortality risk index for PWH. Self-reported functional decline was measured by a modified Lawton-Brody Instrumental Activities of Daily Living questionnaire. Seven cognitive domains were assessed: attention, processing speed, executive functioning, verbal fluency, memory, learning, and motor skills. Two composite PPFs (internal strengths, socioemotional support) were measured by seven, self-report questionnaires (e.g., Grit Scale, Duke Social Support Index).
For Aim 1, baseline variables univariably associated with year 2 functional declines in Poisson regressions were included in multivariable analyses as candidate predictors. A multivariable Poisson regression including candidate predictors, controlling for baseline functional declines, was conducted using backwards stepwise selection with the AIC stopping rule. For Aims 2 and 3, overall model fit statistics (likelihood ratio tests, AIC, Nagelkerke R2) compared models including PPFs using complete case analysis (N=61).
Results:
In the final model (N=76), baseline predictors of greater functional declines included younger age (IRR=0.97, p<0.01), greater current depressive symptoms (IRR=1.03, p=0.02), lifetime MDD (IRR=1.40, p=0.08), and lower platelets (IRR=1.00, p=0.05). No cognitive domain consistently predicted functional decline. The CHARTER Index outperformed both VACS Indices (ps<0.05). The addition of internal strengths improved the CHARTER risk group and both VACS Indices, but not the CHARTER Index risk score. No PPFs improved the final model.
Conclusions:
Age, platelets, and depression are consistent predictors of perceived functional decline among PWH; however, external validation of the CHARTER Index is necessary in larger age-diverse cohorts. The lack of findings with domain-specific cognition may be explained by multiple cognitive domains being involved in everyday tasks. As a robust predictor, depression should be routinely considered in assessing risk for functional decline. By including behavioral predictors, the CHARTER Index outperformed the VACS Index, supporting its promising utility in clinical and research settings. Internal strengths can aid prediction of functional decline, particularly when other behavioral measures are unavailable. |
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