HIV, aging, and advance care planning: are we successfully planning for the future?
BACKGROUND
Studies of advance care planning (ACP) completion rates in HIV-infected persons pre-date the "graying" of the HIV epidemic. We sought to examine current ACP completion rates and factors influencing completion among HIV-infected persons.


METHODS
HIV-1-seropositive persons aged 45-65 years on effective antiretroviral therapy for a minimum of 6 months were enrolled in a cross-sectional survey. Likelihood of ACP was assessed by demographic and clinical characteristics, tested with odds ratios (OR) and 95% Wald confidence intervals (CI), and adjusted for gender.


RESULTS
Of 238 participants, 112 (47%) completed ACP. Persons ≥55 years of age (OR 2.8; CI 1.6,5.0; p<0.001), males (OR 4.1; CI 1.8,9.3; p=0.004), and persons with higher education (OR 2.2; CI 1.3,4.0; p=0.007) were more likely to have completed ACP. Persons with a cardiac event were more likely to have completed ACP (OR 5.5; CI 1.6,25; p=0.03), although this effect was diminished after adjusting for gender (OR 4.5; CI 0.95,21.4; p=0.06). HIV infection diagnosed for greater than 5 years was not associated with ACP completion (OR 1.3; CI 0.7,2.7; p=0.4). Current CD4(+) cell counts were similar between those completing and not completing documentation (588 cells/μL and 604 cells/μL, respectively; p=0.7). The likelihood of ACP did not significantly differ with other comorbidities.


CONCLUSIONS
Less than 50% of middle-aged patients in HIV care had documented ACP. In particular, women and those with lower education were at greatest risk of non-completion and may need interventions to improve ACP.
Department of Medicine, Division of Infectious Disease, University of Colorado-Anschutz Medical Campus, Aurora, Colorado 80045, USA. Kristine.Erlandson@ucdenver.edu
Kristine M
KM
Erlandson
Amanda A
AA
Allshouse
Syki
S
Duong
Samantha
S
MaWhinney
Wendy M
WM
Kohrt
Thomas B
TB
Campbell
D032722:Advance Care Planning; D000368:Aged; D000375:Aging; D003120:Colorado; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012737:Sex Factors; D012959:Socioeconomic Factors