Many new HIV diagnoses in people aged over 50, including recent infections

In the United Kingdom, one in twelve HIV diagnoses are of a person over the age of 50. Whilst rates of late diagnosis are high in older adults, just under half of these diagnoses are thought to be of an infection that was acquired when the person was over the age of 50.

Ruth Smith of the Health Protection Agency announced these findings at the joint conference of the British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH) last week. Also at the conference, other studies highlighted issues involved in the treatment and care of older people with HIV.

During the period 2000 to 2008, one in twelve (8.5%) new adult HIV diagnoses were in a person over the age of 50. The numbers increased year on year, from 304 in 2000 to 787 in 2008.

The profile of people diagnosed over 50 is somewhat different to those diagnosed at a younger age. They are more likely to be male, homosexual and white than other groups. The HPA have noted a number of diagnoses in older heterosexual men who acquired their infection in southeast Asia.

By looking at the CD4 count at the time of diagnosis, the researchers were able to estimate how long each person had had HIV when diagnosed. Just under half (48%) of infections were thought to have been acquired when the person was over 50, suggesting that prevention work cannot ignore older adults.

Nonetheless, late diagnosis is more of a problem in older adults than in younger groups. A total of 48% are diagnosed with a CD4 count below 200 cells/mm³, compared to 33% of people under 50. In gay and bisexual men, double the number of over-50s are diagnosed late compared to younger men (40% and 21% respectively).

Moreover, these late diagnoses make a substantial contribution to short-term mortality. Amongst people diagnosed over the age of 50, 14% of those diagnosed late died within a year, compared to 1% of people not diagnosed late.

Whereas people over the age of 50 represented 11% of the individuals accessing HIV care in 2000, they now make up 17% of those doing so.

Other studies at the conference looked at the treatment and care needs of these older adults. A poster profiled 257 patients aged 50 or over attending HIV services in Brighton. The vast majority were white gay men, their mean age was 58 and they had lived with HIV for an average of 12 years.

85% of patients had at least one co-morbidity, with 43% having three or more. As a result, in addition to anti-HIV drugs, two-thirds of patients were taking medication for other conditions (12% reported five or more other drugs) and 79% of patients were under the care of other medical specialists (dermatology, ENT, cardiology, gastroenterology, etc,). The authors recommended that HIV clinicians should work in close co-operation with these other specialists.

Another poster highlighted the importance of carrying out additional tests and assessments, for example for prostate cancer and other malignancies. Moreover regular review of all medication is required to monitor possible drug-drug interactions.

Finally, the Brighton researchers also presented findings from 20 in-depth qualitative interviews with people with HIV aged between 52 and 78 (mean age 64). Almost all were white gay men.

Some of the key themes were:

• Health: concerns about the unknown effects of HIV and antiretroviral treatment over time; the number of co-morbidities; a desire to have continuity of medical care and more psychosocial support. “Obviously the antiretrovirals are keeping me alive but there must be some long-term damage,” said one interviewee.
• Survival: stories of outliving peers and of not having prepared for the future because none was expected. “They’re all dead and I’m the only one left alive and I’ve got no pension.”
• Self-esteem and rejection, linked to a youth-orientated gay scene, changes in physical appearance and sexual dysfunction. “Who wants an old faggot like me?” was one comment from the interviews.