Relationships between cognition, function, and quality of life among HIV+ Canadian men
To estimate the extent to which HIV-related variables, cognition, and other brain health factors interrelate with other HIV-associated symptoms to influence function, health perception, and QOL in older HIV+ men in Canada.
Cross-sectional structural equation modelling (SEM) of data from the inaugural visit to the Positive Brain Health Now Cohort.
HIV clinics at 5 Canadian sites.
707 men, age ≥ 35 years, HIV+ for at least one year, without clinically diagnosed dementia.
Main outcome measures
Five latent and 21 observed variables from the World Health Organization’s biopsychosocial model for functioning and disability and the Wilson–Cleary Model were analysed. SEM was used to link disease factors to symptoms, impairments, function, health perception, and QOL with a focus on cognition.
QOL was explained directly by depression, social role, health perception, social support, and quality of the environment. Measured cognitive performance had direct effects on activity/function and indirect effects on participation, HP and QOL, acting through self-reported cognitive difficulties and meaningful activities.
The biopsychosocial model showed good fit, with RMSEA < 0.05. This is the first time the full model has been tested in HIV. All of the domains included in the model are theoretically amenable to intervention and many have evidence-based interventions that could be harnessed to improve QOL.
KeywordsCognition Quality of life Disability Health outcomes Multivariable models
Brief Cognitive Ability Measure
Combination antiretroviral therapy
Comparative Fit Index
Central nervous system
EuroQol 5 dimensions with 3 levels
Visual analogue scale for health rating from EuroQol
Hospital Anxiety and Depression Scale
HADS anxiety items
HADS depression items
HIV-specific signs and symptoms
Health-related quality of life
Instrumental activities of daily living
International classification of functioning, disability and health
Mental Health Index
Anxiety items from MHI
Depression items from MHI
Perceived Deficits Questionnaire
Patient Generated Index
Quality of life
- RAND-36 GHP
General health perception
Root mean square error of approximation
Structural equation model
Standardized root mean squared residual
Standardized regression coefficient
Trier inventory for chronic stress
Tucker–Lewis Fit Index
World Health Organization
World Health Organization 5-item well-being index
We want to thank the participants of the Positive Brain Health Now cohort study as well as the community members of the research team and the organizations. They represent COCQ -Sida (Ken Monteith); Aids Committee of Toronto (Sarah Schultz); Positive Living BC (Hesham Ali).
This project was supported by grants from the Canadian Institutes of Health Research (LKF, MJB, NM, TCO-125272), the CIHR Canadian HIV Trials Network (CTN 273), and salary support from the Fonds de Recherche Santé du Québec (LKF) and the Research Institute of the McGill University Health Centre (MJB). None of these funding agencies played any role in the design, data collection, analysis, or interpretation of the study.
Compliance with ethical standards
Conflict of interest
Authors declare that they have no conflicts of interest.
All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The project was approved by the Research Ethics Board of each of the participating institutions.
All participants provided informed consent.
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