Over half of people living with an AIDS diagnosis in
San Francisco are aged 50 or older, investigators report in AIDS Care. The authors believe that the
Californian city “is the first local jurisdiction to have reached this
Improvements in HIV treatment and care mean
that the prognosis of many HIV-positive people is now normal. In addition, it means there is a longer period between HIV diagnosis and any AIDS diagnosis, and that people are living longer with AIDS, resulting in an ever-increasing proportion of people with AIDS who are aged 50 and above.
The study also illustrates the extent to which HIV medicine will be required to overlap with other medical specialties in the care of patients who already have complex medical needs as a result of a previous AIDS diagnosis.
Investigators used San Francisco’s HIV/AIDS
case registry to examine trends in the age distribution of people living with
AIDS in the city between 1990 and 2010 and also age trends in new AIDS
diagnoses over the same period.
The registry is well maintained and, for
each AIDS case, provides data concerning demographics and HIV risk group,
opportunistic infections, date of HIV diagnosis and CD4 cell count and viral
load. The authors also used national registers to compile comparative data
regarding the age distribution of people with AIDS across the United States.
At the end of 2010, there were 9796 people
living with AIDS in San Francisco. Of these, 5112 (52%) were aged 50 or over. The proportion of people aged 50 or over
increased steadily over the 20 years of the study.
In 1990, just 10% of individuals living
with AIDS in the city were 50 or older. The proportion had increased to 24% in
2000, 38% in 2005 and 52% in 2010.
There was a similar trend across the rest
of the United States, with the proportion of older AIDS patients increasing
from 20% in 2001 to 39% in 2009.
The analysis also showed a sharp fall in
the number of new AIDS diagnoses in San Francisco. In 1990, 2047 cases of AIDS
were reported. The figure had fallen to just 331 cases in 2010. The age profile
of people newly diagnosed with AIDS also changed.
In 1990, only 10% of people diagnosed
with AIDS were aged 50 and over. This had increased to 28% in 2010. Between 1990 and 2010, there was a marked
shift in the age distribution of people living with AIDS.
In 1990, people with AIDS in San Francisco had
a median age of 38 years and 48% were aged between 35 and 44. Some 90% of
individuals were aged under 50.
By 2010, however, the median age was 50, only 21% of people were in the 35 to 44 age group and the
proportion of people living with AIDS and who were under 50 years of age had fallen to 48%.
There were significant differences between
older and younger people living with AIDS in 2010.
Compared to younger people, those aged 50
or older were more likely to be white (69%, compared to 56% of those under 50) and to have acquired HIV as a
result of sex with another man (75 vs 68%).
People aged under 50 were more likely to
be Hispanic (22 vs 12%) and to have both sex with other men and injecting drug
use as their HIV risk factors (19 vs 13%).
“Between 1990 and 2010, the population of
PLWA [people living with AIDS] in the USA aged,” comment the investigators. “At the end of 2010, more than half of PLWA in San Francisco were 50 years old or older.”
The authors believe there are two reasons
for their findings: the increasing age of people at the time AIDS was
diagnosed; and the success of antiretroviral therapy in reducing mortality from AIDS.
But the authors emphasise that the ageing
of AIDS patients will bring new challenges.
“Older people with HIV/AIDS face both
HIV/AIDS-related and age-related co-morbidities, such as hypertension, chronic
pain, hepatitis and arthritis, which are associated with poorer physical,
mental and social well-being,” note the authors. “A National Institutes of
Health-commissioned HIV and aging working group has emphasized the need for
research on the interaction of age and HIV infection and also the necessity for
increased community support, caregivers, and systems infrastructure.”