An Exploratory Study of Correlates of Allostatic Load in Older People Living With HIV

• Authors: Pariya L. Fazeli, University of Alabama Birmingham; Drenna Waldrop, Emory University; Ibrahim Yigit, University of Alabama Birmingham; Bulent Turan, University of Alabama Birmingham; Jeff Edberg, University of Alabama Birmingham; Mirjam Kempf, University of Alabama Birmingham; David Vance, University of Alabama Birmingham
• Journal Title: JAIDS: Journal of Acquired Immune Deficiency Syndrome
• Volume: Volume 83, Number 5
• Publisher: Lippincott Williams & Wilkins | 2020-04-15, Pages 441-449
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/QAI.0000000000002293
• Subjects: Health Sciences, Immunology; Biology, Neuroscience; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; weathering; allostasis; HIV; AIDS; aging; neurocognition; Neurocognitive impairment; Health consequences; Cognitive decline; Stress; Adults; Infection; Impact; Risk; Age

Abstract

Background: Older people living with HIV (PLWH) experience poorer outcomes than seronegative counterparts. Allostatic load (AL) markers have shown utility as indicators of cumulative wear-and-tear of stress on biological systems. However, little is known about correlates of AL in PLWH. Methods: Ninety-six PLWH aged 50+ completed a comprehensive neurobehavioral assessment and blood draw. Select AL markers (i.e., 10 blood markers) were available for a subset (n=75) of seronegative controls. AL was operationalized as a sum of markers in the highest risk quartile for: cortisol, DHEA, IL-6, TNF-alpha, C-reactive protein, glucose, total cholesterol, HDL cholesterol, triglycerides, albumin, systolic and diastolic blood pressure, and BMI. Results: PLWH had higher risk levels than seronegatives with small-medium effect sizes for several biomarkers. Among HIV+ African Americans (84% of PLWH), higher AL was associated with lower psychological resilience (rho=−0.27, p=0.02), less physical activity (rho=−0.29, p<0.01), poorer neurocognitive functioning (rho=−0.26, p=0.02), greater basic activity of daily living (BADL) complaints (p<0.01), and diabetes (p<0.01). Multivariable regressions within African American PLWH for significant AL-outcome associations (i.e., neurocognitive function, BADL complaints, diabetes) showed that associations with AL remained significant when adjusting for relevant covariates. Mediation analysis suggested that the association between SES and neurocognitive function was mediated by AL. Conclusion: These exploratory findings are consistent with the larger aging literature, suggesting that lower AL may serve as a pathway to better health and functional outcomes, particularly in African American PLWH. Further, resilience and physical activity may reduce AL in this population.