BHIVA: Most older people with HIV in UK diagnosed recently

The majority of people over 50 living with HIV in the UK have been diagnosed in the last decade, a study finds, rather than being long-term survivors.

However the study also found that people over 50 had, on average, considerably lower CD4 counts when they were diagnosed. While CD4 counts can decline with age, this finding suggests that a higher proportion of the older diagnosed could be late presenters who have lived with HIV unaware for years.

The study was conducted by Professor Jonathan Elford and his team from City University in London. They conducted a questionnaire study between June 2004 and June 2005 examining the clinical, social and behavioural characteristics of patients attending six HIV outpatient clinics in east London ranging from Bart’s Hospital in the City of London out to Barking.

Nearly 2,300 patients were eligible to complete the questionnaire, of whom just under 1,700 agreed to participate, resulting in a response rate of 73% of eligible patients or 63% of all patients attending the clinic. Of responders 1,462 (87%) were either gay/bisexual men (758 in total, of whom 15% were of ethnic minority origin) or heterosexuals of African origin (704, of whom 68% were women), and the figures for the rest of the survey concentrate on these groups.

Overall, 10.9% of the group were 50 years old or more (184 respondents) and a quarter of these (2.6% of the whole group) were over sixty. Another 40 per cent were over 40.

There were significant differences in age distribution between the gay men and the Africans, as might perhaps be expected. Fourteen per cent of the gay men were over 50 compared with about 7.5% of the Africans, with the African men and women having more or less the same average age. However the ethnic minority gay men were younger, with only 6% of this group over 50.

At least three-quarters of people over 50 had been diagnosed with HIV in the last decade. The researchers did not ask each participant how long they’d been diagnosed but instead how old they were when they were diagnosed. Forty per cent were already over 50 at the age of diagnosis and another 44% were over 40. A few of these would be people now in their 60s and 70s who had lived a long time with HIV but a quick calculation shows that between 74% and 84% of the over-50s have been diagnosed since combination therapy became available.

Were they also infected recently? The group would include both people who had acquired HIV in their 50s and late presenters, pointed out Elford, and there was some evidence of late presentation. People diagnosed when they were over 50 had had a baseline CD4 count of 170 cells/mm³ at diagnosis compared with 200 cells/mm³ for people diagnosed in their 40s, 231 for people in their 30s and 374 for people in their 20s. This could be due to the immunological effects of age but is more likely to be explained by a higher likelihood of late diagnosis in the over-50s.

However a large proportion of the group will be people who lived until late middle age before acquiring HIV.

“These are people who managed to avoid HIV for years and then acquired it,” commented Elford. “Did something in their behaviour change? If so, it suggests that HIV testing among those at risk of HIV in the UK should target people in their 40s and 50s as well as younger people.

“The diversity of older people living with HIV will present a continuing challenge for HIV treatment and care among this group in the UK,” he concluded.