Living with HIV has changed a lot in the last 20 years. Before, it was a very serious illness, but now, it can be managed like a chronic condition. People are more concerned about their quality of life (QOL) than just staying alive. As people with HIV get older, they worry about their brain health, like memory and thinking, and how it affects their lives. Even if the virus is under control, many still have cognitive challenges.

In this study, researchers in Canada wanted to understand how different factors related to HIV, brain health, and other symptoms influence how older HIV+ men feel and function. They looked at 707 men over 35 years old, who had HIV for at least a year, but didn’t have dementia. The study used a method called structural equation modeling (SEM) to see how different things connect and affect each other.

This paper is quite detailed and might take some time to read. Make sure you’re well-rested before diving in, but you’ll learn a lot from it! The researchers found many interesting things:

  1. Memory and thinking were affected by age, education, the environment they lived in, and stress. How well they did on memory and thinking tests also affected their daily activities and how they felt about their lives. But it didn’t directly affect their overall quality of life.
  2. Some men reported having cognitive difficulties, like memory problems. This was linked to many things, including how well they did on memory tests, feeling anxious, pain, tiredness, HIV symptoms, and stress. But interestingly, feeling depressed didn’t directly affect their cognitive difficulties. These difficulties did, however, impact their daily roles and activities, and that, in turn, affected their quality of life.
  3. How well someone felt about their health (health perception) was directly influenced by feeling depressed or motivated. Feeling anxious and having HIV symptoms influenced health perception indirectly. Pain and energy levels also had both direct and indirect effects. Physical abilities, beliefs, and the environment they lived in also played a role in how they felt about their health. Health perception, in turn, influenced their overall quality of life, along with feeling depressed, their social roles, the environment they lived in, and having social support.
  4. The study shows that it’s better to have interventions that tackle multiple issues at once rather than just focusing on one problem.

In conclusion, this study tells us a lot about how living with HIV can affect older men and how different things are connected. Researchers learned that it’s not just about the virus, but also about how they feel, think, and live their lives. By understanding these connections, we can work on better ways to support people living with HIV and improve their quality of life.



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.


Open Access: PDF of original journal article