Over 50s - 1 in 12 new diagnoses
posted: 04/05/2010
One in twelve new HIV diagnoses in the UK are in people over the age of 50. Late diagnosis is common among over 50s but almost half of these people were infected after their 50th birthday.
Between 2000 to 2008, one in twelve 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.
Typically - male, gay, white, older
The profile of people diagnosed over 50 is rather different to those diagnosed younger. They are more likely to be male, homosexual and white. Older heterosexual men often got HIV in southeast Asia – usually in Thailand.
Infected after 50 – Prevention’s still needed
By looking at the CD4 count when the people were diagnosed, the researchers were able to estimate how long before diagnosis each person had HIV. Just under half (48%) were infected after the 5oth birthday. HIV prevention cannot ignore older adults.
Late diagnosis is big – some deaths within one year
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.
More on over 50s in Brighton
The Manchester BHIVA/BASHH conference also heard about the treatment and care needs of older adults. One 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% had at least one other health problem, with 43% having three or more. As a result, in addition to anti-HIV drugs, two-thirds were taking medication for other conditions (12% reported five or more other drugs) and 79% 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.
More tests and reviews
Another conference 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.
Brighton men speak
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.
Advice and Information
Coming of Age - a guide to ageing well with HIV - 130 pages, UK, 2010
download is free - it is large (2.8 Mb) pdf file, so please be patient while it downloads
Ahead of Time: A practical guide to growing older with HIV, Austrailia, 2010
Older Adults with HIV - The ROAH study of 1000 adults over 50 by ACRIA, New York
Sources and references
Permalink