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Mortality in HIV - study Estimates Increased Death Risk of 1.6 vs General Population in HIV+ Over 50 Without Comorbidities, Higher in 65-70 Year Olds (2.5)....75% Over 45 Years Old in NY, SF, Boston, Florida
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These are important data. Our current expectations are underestimated for the future regarding aging & mortality, and morbidities. We must update & clarify to the best of our ability based on the data we have, which is limited, future expectations of mortality & morbidity in order to provide a true picture so that a realistic framework for discussion can occur. As it is now there is very little discussion about planning for the future regarding the HIV aging population. Putting aside research into anti-inflammatiry or drug intervention the real problem is special support services & proper and adequate care for the aging populations & the clinics & clinicians including proper education for clinicians, in the USA, and globally. There is no programmatic network in our HIV care system including RWCA that funds services like this, and there is no discussion about addressing this. Lastly, disability will prematurely increase at higher percentages vs the general population so how will we provide home care & living facilities after these individuals are no longer able to care for themselves at home. Remember most HIV+ tend to be single with no partners making care at home much more complicated & difficult.
in some major USA cities 80% of HIV+ diagnosed are over 45 years old. This is an important trend, I thought I would share this data which comes from the respective local DOH with you. The 2nd link below to a study that (2) estimated mortality rate ratio (MRR) (increased death risk) of 1.6 for HIV+ over 50 without comorbidity compared to population controls without comorbidity, which is a 2nd study finding similarly, the 1st by Lohse finding 1.7 increased rate. They estimate 22.8 year (70-74) survival for 50 year old in 2006-2014 range. "For population controls estimated median survival time was 30.2 years (95% CI: 29.5 to 31.1) in 1996-2014.....Among HIV-infected individuals without comorbidity the estimated median survival time from age 50 years was 25.6 years (to age 75.6 years) (95% CI: 23.8 to NA) compared with 34.2 years (age 84.2 years) (95% CI: 29.6 to 38.3) among population controls without comorbidity. MRR was 1.7 (95% CI: 1.2 to 2.3) for HIV-infected individuals compared with population controls. "
Here is link to data of 80% over 45 in US in HIV
80% of HIV+ Are Over 45 / 20% over 60 /50% Over 50 in NY, SF, Boston, Florida - (01/27/17)
Long-Term Mortality in HIV-Infected Individuals 50 Years or Older: A Nationwide, Population-Based Cohort Study - (02/08/16)
Estimated median survival time from age 50 years for HIV-infected individuals increased from 11.8 years (95% CI: 10.2 to 14.5) during 1996-1999 to 22.8 years (20.0-24.2) in 2006-2014. MRR decreased with increasing age from 3.8 (3.1-4.7) for 50-55 years to 1.6 (1.0-2.6) for 75-80 years. In a cohort of well-treated HIV-infected individuals ≥50 years without AIDS-defining events or comorbidity at study inclusion (n = 517). MRR was 1.7 (1.2-2.3) compared with population controls without comorbidity"
www.natap.org/2017/HIV/012717_03.htm
Dec 21, 2016 - 75% of HIV+ are over 40 years old in NY, SF, Massachusetts & Florida - 53% are over 50 years old - 20% over 60.
http://www.natap.org/2017/HIV/012717_03.htm
Italy researchers observe 50% with HIV are over 50 in 2016, which will approach 70%by 2020 and over 75% by 2025: "In 15 years time the HIV geriatric population [65-67 yo] will increase from 4% to 37%"...."In 15 years time the most frail HIV population will increase from 24% [now, 2016] to 48%"....."In 15 years time 34% of PLWH will be disabled" [burden of IADLs - independent activities of daily living] - see graph - appears to predict 30% will experience a fall in 15 years, up from 20% now
Some mistakenly believe HIV survival has been normalized minimizing & underestimating the impact of aging in HIV. CDC reports that in 2013 42% diagnosed with HIV are over 50 years old, 25% over 55, and 6% 65 or older, and 17% were 45-49[https://www.cdc.gov/hiv/group/age/olderamericans/] The CDC previously projected that by 2015, more than half of all HIV-infected Americans will be over 50 years old [https://www.nia.nih.gov/newsroom/features/aging-hiv-responding-emerging-challenge] ; soon they will be over 60. In NY & SF almost 80% with HIV are over 40 years old. In NYC 52% were reported by the NYC Dept of health to be over 50, 32% 50-59 & 20% >60, and of note 24% are 40-49. Among women with HIV in NYC [https://www1.nyc.gov/assets/doh/downloads/pdf/dires/hiv-surveillance-annualreport-2015.pdf] In San Francisco 60% of those living with HIV are over 50 years old, 19% 60-69, and 25% are 40-49, reported by the San Francisco Department of Public Health 2015 [https://www.sfdph.org/dph/files/reports/RptsHIVAIDS/AnnualReport2015-20160831.pdf]I have collected a selection of more recent studies many presented at conferences in the past few months or published very recently that still only representing a fraction of the many studies on these topics.]......In Boston health officials reported in 2015 59% were over 50 and 21% over 60 and 16% 45-49, thus 75% of all HIV-infected were over 45. http://www.mass.gov/eohhs/docs/dph/aids/2015-profiles/city-boston.pdf
In Florida health officials reported 53% are over 50 with 25% 45-49 and 25% over 60. [http://www.floridahealth.gov/\/diseases-and-conditions/aids/surveillance/epi-profiles/2015/state-1415.pdf]
(I believe this may be underestimate) by 2030 30% will be 60 & older & 23% >65, said Linda fried, MD in her talk on HIV & Aging: a new paradigm at NYS AIDS Institute Conference [https://www.youtube.com/watch?v=9alEsXqT0BU]
a recent Dutch study projected that by 2030, 73% of those infected with HIV will be at least 50 years of age and 39% will be 60 years or older .....http://www.natap.org/2016/HIV/PIIS1473309915000560.pdf
Senate Hearing 2013: Older Americans: The Changing Face of HIV/AIDS in America .....[ http://www.aging.senate.gov/hearings/older-americans-the-changing-face-of-hiv/aids-in-america]Sen Nelson of Florida said "30% are over 50 now and in 2 years 50% will be over 50, its actually 53% in 2015 with 25% 40-49; the age group with the highest prevalence is by far over 60 with 25% [http://www.floridahealth.gov/\/diseases-and-conditions/aids/surveillance/epi-profiles/2015/state-1415.pdf].....Sen Collins of maine said HIV+ are experiencing comorbidities a decade sooner.....Sen Warren stated "52% in her state Mass with HIV are >50 yrs old & 15% are 60 or older".
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