Increasing HIV infection among adults aged 50 years and over: a call for heightened awareness

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From: Therapy(Vol. 8, Issue 2)
Publisher: Future Medicine Ltd.
Document Type: Clinical report
Length: 3,739 words
Lexile Measure: 1470L

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Author(s): Ruth D Smith [[dagger]â ] 2 , Meaghan M Kall 1 , Brian D Rice 1 , Valerie C Delpech 1

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HIV infection; HIV transmission; late diagnosis; older adult; short-term mortality

Effective antiretroviral therapy has led to a reduction in HIV-related deaths and has improved the life expectancy of individuals infected with HIV. In countries where antiretroviral therapy is widely available, mortality rates among people living with HIV are now approaching the same levels as those in the HIV-uninfected population [1] . Modeling studies have estimated as much as 50 years of life remaining in individuals who are diagnosed at an early stage of infection [2-â4] . As a result, the median age of people living with HIV in developed countries is increasing [101-â103] . In the UK, the median age of individuals living with diagnosed HIV rose from 36 years in 2000 to 41 years in 2009 [103] . A total of one in five (12,063/65,319) adults seen for HIV care in the UK in 2009 was aged 50 years or above (older adults) compared to one in ten (2432/22,575) in 2000 [103] . Similarly, older adults now represent a quarter of people living with HIV in the USA, an increase from 17% in 2000 [102] . The majority of older adults accessing HIV-related care in the UK in 2009 were aged between 50 and 59 years (72%), with 5% aged 70 years and over [103] .

The increase in prevalent cases of HIV among older adults is due to an aging cohort of HIV-infected persons on effective therapies, as well as a rise in new diagnoses among this age group. In the UK in 2009, one in 12 adults newly diagnosed with HIV and one in four adults with an AIDS diagnoses, were aged 50 years or over [104] . The ratio of one in 12 new HIV diagnoses is lower than that reported in the USA in 2005 (one in seven) [102] , France (one in six in 2008) [5] or Italy (one in eight between 2004 and 2007) [6] . In Western Europe as a whole in 2007, adults aged 50 years and above represented one in eight of all new HIV diagnoses [7] . By contrast, older people comprise one in 11 and one in 25 newly diagnosed persons in central and eastern Europe, respectively, and are experiencing more recent epidemics primarily driven by intravenous drug use among young people [7] .

The increase in new diagnoses among older adults suggests that the overall rise in the number of older adults living with diagnosed HIV is also due to the onward transmission of HIV. Using a Markov Chain of HIV progression [8] , based on CD4+ cell count, it was estimated that 48% of the 4001 older adults newly diagnosed with HIV in the UK between 2000 and 2007 probably acquired their infection aged 50 years and over [9] . This finding has important health promotion implications for this group.

An examination of older adults newly diagnosed in the UK between 2000 and 2007, which was recently published by our group,...

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Gale Document Number: GALE|A252312100