Abstract
INTRODUCTION: Disability disproportionally impacts people living with HIV (PLWH). The burden and determinants of disability among PLWH in Asia have not been well studied. METHODS: We conducted a multi-country observational cross-sectional study in five cities in Asia involving PLWH and age- and sex-matched controls living without HIV from March 2020 to November 2023. We compared the prevalence of disability (measured by World Health Organization Disability Assessment Schedule 2.0, WHODAS 2.0) between PLWH and controls, and determined the association between living with HIV and disability using multivariable logistic regression and mediation analysis. RESULTS: A total of 1004 PLWH and 416 age- and sex-matched controls were enrolled. PLWH (mean age 53.6 ± 10.3 years, 84.4% male, 72.2% ≥1 comorbidities) had a higher Charlson Comorbidity Index, more depression, anxiety, stress, social isolation and loneliness, and poorer cognitive performance. The prevalence of disability was 50.9% among PLWH and 40.6% among controls (p<0.001). PLWH had significantly higher WHODAS 2.0 complex score, and significantly more PLWH had impairments in all of the six domains of disability. The presence of disability correlated with living with HIV after adjusting for demographic characteristics, physical health parameters and cognition, but not after adjusting for socio-behavioural variables and mental health parameters. Mediation analysis showed that living with HIV had a significant indirect effect on disability mediated by social isolation, mental health disorders and poor cognitive performance. CONCLUSIONS: PLWH in Asia had a higher burden of disability as compared with matched controls. The effect of living with HIV on disability was mediated by social isolation, mental health disorders and impaired cognition. Future work should be directed to developing interventions that mitigate these conditions with the goal of reducing disability among PLWH.