Considerations and discussions about later life among people living with HIV: insights from a nationwide cross-sectional study in Japan

The increasing population of older people living with human immunodeficiency virus (PLWH) highlights the importance of advance care planning (ACP) and tailored approaches to later life and end-of-life care. This study examined the extent to which PLWH consider their own aging and end-of-life stage, their discussion of these topics with healthcare providers, and factors associated with such discussions. PLWH aged ≥50 years were recruited from nine hospitals and one clinic in Japan. Among 715 eligible participants, 48.9% had considered the person they would like to entrust with important decisions, and 47.8% had considered the preferred medical treatments at the end of life. However, fewer than 10% of the participants had discussed their own aging and end-of-life stage with healthcare providers. In the multivariate analysis, the following factors were significantly associated with such discussions: consideration of late-life and end-of-life planning (β = 0.226, p < 0.001), shared decision-making (β = 0.157, p < 0.001), over 70 years of age, very good perceived health status, highest educational level, and social support. These findings emphasize the need to create opportunities for PLWH to concretely reflect on their aging and end-of-life preferences and to facilitate communication with healthcare providers to promote ACP.