New Analysis Projects Older Ages and Rising Number of Patients with HIV by 2030

The age distribution of patients with HIV using antiretroviral therapy (ART) will increase in the coming years, with 54% of that population projected to be aged ≥50 years by 2030, according to a new analysis led by researchers at the Johns Hopkins Bloomberg School of Public Health.

Since the development of ART in the late 1990s, the life expectancy of patients with HIV has significantly improved. However, without a cure, “the HIV epidemic will persist among populations infected with HIV for decades to come,” wrote authors led by Keri Althoff, PhD, MPH, associate professor, Department of Epidemiology, Bloomberg School of Public Health, in the study published in the November issue of the journal AIDS.

“As such, it is critical to prepare and strengthen HIV care systems to meet the needs of people aging with HIV, including strategies for long-term viral suppression, ensuring uninterrupted access to ART and prevention and care for comorbid conditions,” continued researchers.

To project the future age distribution of ART users, Althoff and colleagues conducted 2 scenarios using PEARL (ProjEcting Age, multimoRbidity, and poLypharmacy), a model informed by data from the US Centers for Disease Control and Prevention and the North American AIDS Cohort Collaboration on Research and Design. The PEARL model simulated patients in 15 subgroups of sex-and-HIV acquisition risk and race/ethnicity.

In the baseline scenario, PEARL projected the number of patients with HIV using ART will increase from approximately 670 000 in 2020 to 910 000 by 2030, if current trends in new HIV infections continue, according to the study. Furthermore, the model projected the median age of ART users will increase from 50 years in 2020 to 52 years in 2030, with use among those aged over 64 years also rising, from 11% to 23%.

The second model assumed that the US would reach goals set forth in the federal initiative Ending the HIV Epidemic: A Plan for America (EHE). The initiative was announced in 2019 and aimed for the US to reach a 75% reduction in new HIV diagnoses by 2025 (EHE75%) and at least a 90% decrease by 2030. In this scenario, PEARL projected that the number of patients with HIV using ART will increase by 7% from 2020 to 2030.

Under both scenarios, PEARL projected that nearly 25% of ART users will reach 65 years of age or older by 2030.

“These findings clarify that the HIV epidemic will not be ending any time soon by focusing solely on reducing new infections,” said Althoff, in a press release from the Bloomberg School. “Additionally, nearly 1 in 4 people with HIV will be 65 years or older in the next decade, and we need to prepare to meet the medical needs of these individuals. Older adults with HIV are heavy consumers of health care, due to the increased burden of comorbidities and declines in physical and cognitive functioning related to both aging and HIV infection.”

Researchers also estimated the projected size and age distribution by 2030 within subgroups in the baseline scenario and found:

• A 50% increase in the proportion of Black men who have sex with men (MSM) with a median age of 42 years.
• A 28% increase in the number of Black heterosexual women with HIV with a median age of 56 years.
• A 14% increase in the number of White MSM with a media age of 59 years.

“We know that the population of people with HIV is diverse by gender, race, ethnicity, and HIV- acquisition risk,” said Althoff. “Changes in the size and age distribution among subgroups can help us plan for the health care that will be needed over the next decade.”

Even if EHE goals are achieved, the researchers noted that health systems must be ready to meet the needs of a large, older HIV population.

“It is critical to prepare and strengthen HIV care systems to meet the needs of the changing epidemic, including strategies for long-term viral suppression, ensuring uninterrupted access to ART and prevention and care for comorbid conditions that will likely grow in burden among this aging population,” concluded authors.