Sociodemographic and rural dispersion study of people living with HIV aged ≥65 years at a tertiary care hospital in Castilla-La Mancha.

INTRODUCTION

The aging of people living with HIV (PLWH) poses new clinical and social challenges, particularly in rural settings. Loneliness, social isolation, and frailty have been identified as key risk factors in this population. The aim of this study is to describe the sociodemographic, clinical, and psychometric characteristics of PLWH aged ≥65 years in a geographically dispersed rural area, and to analyze factors associated with loneliness, social isolation, affective symptoms, and frailty.

METHODS

Cross-sectional observational study including 60 patients aged ≥65 years followed at the University Hospital of Toledo. Validated scales were used: UCLA-3 (loneliness), LSNS-R (social isolation), HADS (anxiety/depression), and Fried (frailty). Sociodemographic, clinical, and immunovirological variables were analyzed using bivariate/multivariate models.

RESULTS

Twenty percent of participants reported feeling lonely, and 5% had significant loneliness. Social isolation was observed in 21.7%, depressive symptoms in 18.3%, and clinically relevant anxiety in 16.7%. Frailty was present in 31.7% of the cohort. In multivariate analysis, living alone was associated with increased loneliness (OR: 5.57; p=0.0038) and frailty (OR 6.91; p=0.029). Psychotropic drug use was linked to greater perceived loneliness (OR 6.89; p=0.043). Women showed higher scores in loneliness (p<0.002) and greater use of antidepressants and benzodiazepines (p=0.011). No differences were observed between rural and urban populations. Historical severe immunosuppression was associated with greater frailty (p=0.0096).

CONCLUSIONS

PLWH aged ≥65 years show a high prevalence of loneliness and frailty, associated with social vulnerability and cumulative immunological damage. Multidimensional care strategies should address psychosocial factors and the long-term impact of immune damage.