Growing Old with HIV

The number of Americans living with HIV who are aged over sixty-five is projected to grow rapidly over the next decade and will result in large numbers of patients who have multiple co-morbidities in addition to HIV, Dr. Parastu Kasaie of Johns Hopkins University told the Conference on Retroviruses and Opportunistic Infections (CROI 2021) on March 8, 2021.

The number of people living with HIV over the age of sixty-five doubled from 53,000 in 2013 to 105,000 in 2018. By 2030, over twenty-five percent of people taking HIV treatment will be over the age of sixty-five. Half will be over the age of fifty-three. The total number of people taking HIV treatment will rise from 678,000 in 2020 to 929,000 in 2030. The prevalence of anxiety is expected to increase from 36% to 48%, while the prevalence of depression will increase from 47% to 49%. By 2030, 36% of people taking antiretroviral therapy are expected to have multimorbidity—in other words, at least two of the physical co-morbidities in addition to HIV.

These figures come from mathematical modelling, which includes the CDC surveillance data and detailed analysis of data on the associations between smoking, body mass index, hepatitis C, depression, anxiety, hypertension, diabetes, raised lipids, chronic kidney disease, cancer, myocardial infarction, and end-stage liver disease in order to project the burden of other health conditions (comorbidities).

While the prevalence of multimorbidity is expected to remain relatively low in people in their thirties (12%) and their forties (25%), the prevalence will increase more in the oldest age groups, which are also the groups whose total sizes are expected to increase the most. Among people over the age of 70, the prevalence of multimorbidity is expected to increase from 58% in 2020 to 69% in 2030. By demographic group, the largest increases in absolute numbers of people with multimorbidity will be among Black men who have sex with men. In relative terms, the largest increases in multimorbidity will be in Latina women and Latinx injecting drug users.

“It is uncertain if the current healthcare systems will be able to support care for multimorbid populations with HIV as they continue to grow in size over time,” Dr. Kasaie said in his presentation. “This promotes the need for new HIV care models that build out additional support for prevention and management of comorbidities among people ageing with HIV.”

—Reporting by Hank Trout

Hank Trout, Senior Editor, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a forty-year resident of San Francisco, where he lives with his husband Rick.