Skip to main content


Log in

A longitudinal view of successful aging with HIV: role of resilience and environmental factors

  • Published:
Quality of Life Research Aims and scope Submit manuscript



The purpose of this study is to estimate the extent to which people aging with HIV meet criteria for successful aging as operationalized through HRQL and maintain this status over time. A second objective is to identify factors that place people at promise for continued successful aging, including environmental and resilience factors.


Participants were members of the Positive Brain Health Now (BHN) cohort. People ≥ 50 years (n = 513) were classified as aging successfully if they were at or above norms on 7 or 8 of 8 health-related quality of life domains from the RAND-36. Group-based trajectory analysis, regression tree analysis, a form of machine learning, and logistic regression were applied to identify factors predicting successful aging.


73 (14·2%) met criteria for successful aging at entry and did not change status over time. The most influential factor was loneliness which split the sample into two groups with the prevalence of successful aging 28·4% in the “almost never” lonely compared to 4·6% in the “sometimes/often” lonely group. Other influential factors were feeling safe, social network, motivation, stigma, and socioeconomic status. These factors identified 17 sub-groups with at least 30 members with the proportions classified as aging successfully ranging from 0 to 79·4%. The nine variables important to classifying successful aging had a predictive accuracy of 0.862. Self-reported cognition but not cognitive test performance improved this accuracy to 0.895. The two groups defined by successful aging status did not differ on age, sex or viral load, nadir and current.


The results indicate the important role of social determinants of health in successful aging among people living with HIV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Piggott, D. A., Erlandson, K. M., & Yarasheski, K. E. (2016). Frailty in HIV: Epidemiology, biology, measurement, interventions, and research needs. Current HIV/AIDS Reports, 13(6), 340–348.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Escota, G. V., O’Halloran, J. A., Powderly, W. G., & Presti, R. M. (2018). Understanding mechanisms to promote successful aging in persons living with HIV. International Journal of Infectious Diseases, 66, 56–64.

    Article  PubMed  Google Scholar 

  3. Vance, D. E., McGuinness, T., Musgrove, K., Orel, N. A., & Fazeli, P. L. (2011). Successful aging and the epidemiology of HIV. Clinical Interventions in Aging, 6, 181–192.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rowe, J. W., & Kahn, R. L. (1997). Successful aging. Gerontologist, 37(4), 433–440.

    Article  CAS  PubMed  Google Scholar 

  5. Cosco, T. D., Prina, A. M., Perales, J., Stephan, B. C., & Brayne, C. (2014). Operational definitions of successful aging: A systematic review. International Psychogeriatrics, 26(3), 373–381.

    Article  PubMed  Google Scholar 

  6. Michel, J. P., Graf, C., & Ecarnot, F. (2019). Individual healthy aging indices, measurements and scores. Aging Clinical and Experimental Research.

    Article  PubMed  Google Scholar 

  7. Halkitis, P. N., Kapadia, F., Ompad, D. C., & Perez-Figueroa, R. (2015). Moving toward a holistic conceptual framework for understanding healthy aging among gay men. Journal of Homosexuality, 62(5), 571–587.

    Article  PubMed  Google Scholar 

  8. Kahana, E., & Kahana, B. (2001). Successful aging among people with HIV/AIDS. Journal of Clinical Epidemiology, 54(Suppl 1), S53–S56.

    Article  PubMed  Google Scholar 

  9. Lafortune, L., et al. (2016). Behavioural Risk Factors in Mid-Life Associated with Successful Ageing, Disability, Dementia and Frailty in Later Life: A Rapid Systematic Review. PLoS One, 11(1), e0144405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Malaspina, L., et al. (2011). Successful cognitive aging in persons living with HIV infection. Journal of Neurovirology, 17(1), 110–119.

    Article  PubMed  Google Scholar 

  11. Mayo, N. E., et al. (2020). Relationships between cognition, function, and quality of life among HIV+ Canadian men. Quality of Life Research, 29(1), 37–55.

    Article  PubMed  Google Scholar 

  12. Mayo, N. E., Brouillette, M. J., & Fellows, L. K. (2018). Estimates of prevalence of cognitive impairment from research studies can be affected by selection bias. Journal of Acquired Immune Deficiency Syndromes, 78(2), e7–e8.

    Article  PubMed  Google Scholar 

  13. Hays, R. D., & Morales, L. S. (2001). The RAND-36 measure of health-related quality of life. Annals of Medicine, 33(5), 350–357.

    Article  CAS  Google Scholar 

  14. Ware, J. E., Jr., et al. (1986). Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care,". Lancet, 1(8488), 1017–1022.

    Article  Google Scholar 

  15. Hopman, W. M., et al. (2000). Canadian normative data for the SF-36 health survey. Canadian Medical Association Journal, 163(3), 265–271.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. O’Connell, K. A., & Skevington, S. M. (2012). An international quality of life instrument to assess wellbeing in adults who are HIV-positive: a short form of the WHOQOL-HIV (31 items). AIDS and Behaviour, 16(2), 452–460.

    Article  Google Scholar 

  17. Sullivan, M., Edgley, K., & DeHousx, E. (1990). A survey of multiple sclerosis, part 1: Perceived cognitive problems and compensatory strategy use. Canadian Journal of Rehabilitation, 4, 99–105.

    Google Scholar 

  18. Brouillette, M. J., Fellows, L. K., Finch, L., Thomas, R., & Mayo, N. E. (2019). Properties of a brief assessment tool for longitudinal measurement of cognition in people living with HIV. PLoS One, 14(3), e0213908.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The connor-davidson resilience scale (CD-RISC). Depression and Anxiety, 18(2), 76–82.

    Article  PubMed  Google Scholar 

  20. Cesari, M., et al. (2018). Evidence for the domains supporting the construct of intrinsic capacity. The Journals of Gerontology, Series A: Biological Sciences, 73(12), 1653–1660.

    Article  Google Scholar 

  21. Lee, J. E., Kahana, B., & Kahana, E. (2017). Successful aging from the viewpoint of older adults: Development of a brief successful aging inventory (SAI),". Gerontology, 63(4), 359–371.

    Article  PubMed  Google Scholar 

  22. Fazeli, P. L., Montoya, J. L., McDavid, C. N., & Moore, D. J. (2018). Older HIV+ and HIV- Adults Provide Similar Definitions of Successful Aging: A Mixed-Methods Examination. Gerontologist.

    Article  PubMed Central  Google Scholar 

  23. Solomon, P., Letts, L., O’Brien, K. K., Nixon, S., Baxter, L., & Gervais, N. (2018). I’m still here, I’m still alive’: Understanding successful aging in the context of HIV. International Journal of STD & AIDS., 29(2), 172–177.

    Article  Google Scholar 

  24. Tate, R. B., Swift, A. U., & Bayomi, D. J. (2013). Older men’s lay definitions of successful aging over time: the Manitoba follow-up study. The International Journal of Aging and Human Development, 76(4), 297–322.

    Article  PubMed  Google Scholar 

  25. Fazeli, P. L., Woods, S. P., & Vance, D. E. (2019). Successful functional aging in middle-aged and older adults with HIV. AIDS and Behaviour.

    Article  Google Scholar 

  26. Conti, A. A., & Conti, A. (2010). Frailty and resilience from physics to medicine. Medical Hypotheses, 74(6), 1090–2010.

    Article  PubMed  Google Scholar 

  27. Whitson, H. E., Duan-Porter, W., Schmader, K. E., Morey, M. C., Cohen, H. J., & Colon-Emeric, C. S. (2016). Physical resilience in older adults: Systematic review and development of an emerging construct. J The Journals of Gerontology, Series A: Biological Sciences, 71(4), 489–495.

    Article  Google Scholar 

  28. Worthington, C., O’Brien, K., Myers, T., Nixon, S., & Cockerill, R. (2009). Expanding the lens of HIV services provision in Canada: Results of a national survey of HIV health professionals. AIDS Care, 21(11), 1371–1380.

    Article  PubMed  Google Scholar 

  29. Stevens, M. E., & Nixon, S. A. (2016). Research on rehabilitation interventions for adults living with HIV: a scoping review. International Journal of Rehabilitation Research, 39(2), 106–116.

    Article  PubMed  Google Scholar 

  30. Althoff, K. N., Smit, M., Reiss, P., & Justice, A. C. (2016). HIV and ageing: improving quantity and quality of lif. Current Opinion in HIV AIDS., 11(5), 527–536.

    Article  PubMed  Google Scholar 

  31. Mayo, N. E., et al. (2017). In support of an individualized approach to assessing quality of life: Comparison between patient generated index and standardized measures across four health conditions. Quality of Life Research, 26(3), 601–609.

    Article  PubMed  Google Scholar 

  32. Mikkonen, J. R. D. (2010). Social determinants of health: The canadian facts, Toronto: York University School of Health Policy and Management.

Download references


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.

Author information

Authors and Affiliations




NEM: conception of project, supervision of analysis, drafted the paper, tables and figures, verified accuracy of all data in the paper, made edits to paper based on co-authors comments. MJB: recruitment of participants, interpretation of results, editorial comments to paper. LN: carried out the analysis under supervision of NM an ND; verified accuracy of all data in the paper, editorial comments on the paper. ND: provided guidance on the data analysis, provided comments on the paper. MH, recruitment of participants, interpretation of results, editorial comments to paper. FS, recruitment of participants, interpretation of results, editorial comments to paper. GS, recruitment of participants, interpretation of results, editorial comments to paper. RT, recruitment of participants, interpretation of results, editorial comments to paper. LK, interpretation of results, editorial comments to paper.

Corresponding author

Correspondence to Nancy E. Mayo.

Ethics declarations

Conflict of interest

Authors declare that they have no conflicts of interest.

Ethical approval

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.

Informed consent

All participants provided informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mayo, N.E., Brouillette, MJ., Nadeau, L. et al. A longitudinal view of successful aging with HIV: role of resilience and environmental factors. Qual Life Res 31, 1135–1145 (2022).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: