The numbers of Americans living with HIV who are aged over 65 is projected to grow rapidly over the next decade and will result in large numbers of patients who have multiple co-morbidities in addition to HIV, Dr Parastu Kasaie of Johns Hopkins University told the virtual Conference on Retroviruses and Opportunistic Infections (CROI 2021) today.
“It is uncertain if the current healthcare systems will be able to support care for multimorbid populations with HIV as they continue to grow in size over time,” Kasaie said. “This promotes the need for new HIV care models that build out additional support for prevention and management of comorbidities among people ageing with HIV.”
The figures come from mathematical modelling, for which key inputs include Centers for Disease Control and Prevention (CDC) surveillance data and detailed analysis of people starting HIV treatment, CD4 count, age, dropping in and out of care, risk factors (smoking, body mass index) and the incidence of co-morbidities in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), which includes over 130,000 people living with HIV.
The researchers used data on the associations between smoking, body mass index, hepatitis C, depression, anxiety, hypertension, diabetes, raised lipids, chronic kidney disease, cancer, myocardial infarction and end-stage liver disease in order to project the burden of other health conditions (co-morbidities) up to 2030. They looked specifically at 15 sub-groups, defined by their gender, ethnicity and route of acquiring HIV.
Existing figures from CDC already showed that the numbers of people living with HIV over the age of 65 doubled from 53,000 in 2013 to 105,000 in 2018.
The model projects that by 2030, over 25% of people taking HIV treatment will be over the age of 65. Half will be over the age of 53. The total number of people taking treatment will rise from 678,000 in 2020 to 929,000 in 2030.
The prevalence of anxiety is expected to increase from 36% to 48%, while the prevalence of depression increases from 47% to 49%.
There are substantial increases in the prevalence of chronic kidney disease (from 16% to 26%), diabetes (15% to 24%) and myocardial infarction (3% to 9%). More encouragingly, end-stage liver disease and raised lipids barely change, while hypertension is projected to decrease (from 35% to 31%). Cancer decreases in most demographic groups, but increases in injecting drug users – this might be due to changes in the age profile of this group, with more drug users reaching ages at which cancers are more common, as well as risk factors such as hepatitis C and smoking.
By 2030, 36% of people taking antiretroviral therapy are expected to have multimorbidity – in other words at least two of the physical co-morbidities in addition to HIV.
While the prevalence of multimorbidity will remain relatively low in people in their thirties (12%) and their forties (25%), the prevalence increases more in the oldest age groups, which are also the groups whose total sizes are expected to most increase. Among people over the age of 70, the prevalence of multimorbidity is expected to increase from 58% in 2020 to 69% in 2030, corresponding to an additional 71,000 individuals living with two or more physical co-morbidities.
By demographic group, the largest increases in absolute numbers of people with multimorbidity will be among Black men who have sex with men. In relative terms, the largest increases in multimorbidity will be in Latina women and Latinx injecting drug users.
The study’s projections don’t reflect any improvements in HIV prevention that might occur over the next decade. Nor do they reflect the potential impacts of the COVID-19 pandemic, including interruptions in medical care, less screening for co-morbidities and increased mortality in the oldest age groups.
Kasaie P et al. Multimorbidity in people with HIV using ART in the US: projections to 2030. Conference on Retroviruses and Opportunistic Infections, abstract 102, 2021.