Five-year disability trajectories and associated factors among adults aging with HIV in the Ontario HIV Treatment Network Cohort Study

Disability among adults aging with HIV may be episodic and change over time. Guided by the Episodic Disability Framework, we examined disability trajectories, year-to-year fluctuations, and contextual factors associated with disability among adults aging with HIV over time. Annual disability data were collected from participants in the Ontario HIV Treatment Network Cohort Study between 2019 and 2023 (n = 1,896; 6,524 person-years). Disability severity was measured using the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0). Growth mixture modeling identified distinct disability trajectories, and year-to-year fluctuations were quantified using the intraindividual interquartile range (iIQR). We applied multinomial logistic regression to examine factors associated with disability trajectories. The mean age of participants was 51.8±12.1 years, 77% were men, and 58% were White. The mean duration since HIV diagnosis was 16.5±9.3 years. Three disability trajectories were identified: low disability (28.2%), moderate disability (53.0%), and high disability (18.9%). Disability fluctuations increased across trajectories, with the smallest variability observed in the low disability trajectory (average iIQR = 0.22) and greater variability in the moderate (2.82) and high (4.55) disability trajectories. Factors associated with the high disability trajectory included identifying as a woman, lower income, smoking, recent substance use, no alcohol use, greater comorbidity, and higher HIV stigma. Older age, identifying as Black, higher income, and greater social support were associated with the low disability trajectory. Adults aging with HIV experienced heterogenous and dynamic disability trajectories. Modifiable factors including health behaviors, stigma, and social support may influence disability over time.