CATIE News

28 July 2020 

Loneliness linked to poorer brain health and reduced quality of life in HIV

  • Researchers found that Canadians with HIV were more likely to be lonely than average
  • Unlike the general population, loneliness was more common among younger people with HIV
  • Interventions to relieve loneliness could reduce the risk of health conditions

Among HIV-negative people, studies have found that loneliness can interfere with mental health, cognitive functioning and quality of life. In this population, one analysis has found that persistent loneliness is associated with a 26% increased risk of dying over a subsequent period of seven years after it was diagnosed/recognized. In middle-aged and older adults, loneliness has been associated with an increased risk for dementia. In general, studies have found that loneliness is more common among people with chronic health conditions.

Loneliness and HIV

Now that HIV has become a chronic health condition thanks to effective treatment, Canadian researchers have turned to studying other issues that can affect the health of this population. A team of researchers at several Canadian clinics have cooperated to assess the impact of loneliness on the health and well-being of more than 800 mostly middle-aged HIV-positive people. The researchers found that HIV-positive people were more likely to be lonely than the average HIV-negative person in Canada. They also found that HIV-positive people with loneliness tended to be “younger, less mobile and were more likely to use opioids.” Furthermore, HIV-positive people who were lonely tended to have problems with memory, thinking clearly and mood. The researchers also found that HIV-positive people had issues with physical health and reduced quality of life.

The research team suggested ideas for studying the impact of loneliness over the long-term as well as interventions to reduce loneliness in HIV-positive people.

Study details

Researchers at clinics in Hamilton, Montreal, Toronto and Vancouver recruited participants for a study on brain health—the Positive Brain Health Now cohort. One analysis from this group focused on loneliness. The researchers collected health-related information from participants when they entered the study as well as from their medical records.

The average profile of the 834 HIV-positive participants upon entering the study was as follows:

  • 85% men, 15% women
  • age – 53 years

In addition to a variety of assessments, the research team used a validated loneliness survey.

Results

According to the researchers, the proportions of people who had different degrees of loneliness were as follows (note that percentages do not total 100 due to rounding):

  • quite often lonely – 18%
  • sometimes lonely – 46%
  • almost never lonely – 37%

There were no differences in the distribution of loneliness between men and women.

Compare and contrast

The researchers reviewed data from surveys of HIV-negative Canadians and found that about 10% of this population had what they called “persistent loneliness.” As a result, the HIV researchers stated: “This suggests that middle-aged and older people living with HIV in Canada are facing substantially greater social adversity than what might be expected due to aging alone.”

Loneliness had no relationship to HIV viral load or CD4+ cell counts.

The researchers were surprised to find that HIV-positive people who stated that they were “almost never lonely” were older than those who reported loneliness. The study team stated this finding “is in contrast to the general population, where loneliness in those middle-aged or older tends to increase with age.”

The researchers speculated that this finding may reflect what they called “survivor bias.” That is, this subgroup of HIV-positive people who were almost never lonely may be more resilient, having lived with HIV before 1996 “when being part of resilient social networks may have been vital to survival.”

HIV-positive people who were lonelier had multiple factors associated with loneliness, including the following:

  • poverty
  • co-existing health conditions, particularly lung disease and peripheral neuropathy (injured nerves in the feet, legs and hands)
  • visible changes in body shape arising from the HIV lipodystrophy syndrome
  • self-reported fatigue, pain or low motivation

Substance use

There was no difference in the use of alcohol, marijuana or tobacco between people who were very lonely or not lonely. The study team did find that people with high levels of loneliness were “more likely to report opioid use whether recreational or prescribed.” When the researchers adjusted their findings for the presence of physical pain, the association between loneliness and opioid use remained. This caused the researchers to suggest that some people might be using opioids to “address psychological pain.”

Memory and thinking clearly

People who reported minimal levels of loneliness tended to do better on cognitive assessments than people who were very lonely. This better performance was likely “clinically meaningful,” according to the researchers.

Other outcomes

According to the study team, loneliness had a negative impact on issues such as the following:

  • self-rated health
  • health-related quality of life
  • overall quality of life
  • mood
  • physical activity

For the future

The study team would like to monitor participants over the course of several years to assess changes in loneliness, its impact on health and factors contributing to loneliness. The findings from such a longitudinal study could then be used to develop interventions to target factors that fuel loneliness. The researchers noted that such interventions may need to address multiple drivers of loneliness.

–Sean R. Hosein

REFERENCES:

  1. Harris M, Brouillette MJ, Scott SC, et al. Impact of loneliness on brain health and quality of life among adults living with HIV in Canada. JAIDS. 2020;84(4):336-344.
  2. Kuiper JS, Zuidersma M, Oude Voshaar RC, et al. Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Research Reviews. 2015;22:39-57.
  3. Lara E, Martín-María N, De la Torre-Luque A, et al. Does loneliness contribute to mild cognitive impairment and dementia? A systematic review and meta-analysis of longitudinal studies. Ageing Research Reviews. 2019;52:7-16.
  4. Rico-Uribe LA, Caballero FF, Martín-María N, Cabello M, Ayuso-Mateos JL, Miret M. Association of loneliness with all-cause mortality: A meta-analysis. PLoS One. 2018;13(1):e0190033.