Substantial gap in primary care: older adults with HIV presenting late to care

Abstract

Background Late diagnosis of human immunodeficiency virus (HIV) is associated with increased morbidity and mortality, and represents a serious public health concern. Methods A retrospective medical record review was conducted on 188 patients with newly diagnosed HIV at a large academic center’s HIV clinic from 1/2010 to 12/2019. Patient demographic data, HIV staging, and response to combination antiretroviral therapy (cART) as measured by HIV viral suppression at 12 weeks (HIV RNA < 50 copies) were collected. Bivariate analyses were applied to compare patients ≥50 years old to those < 50 years old. Results Over two-thirds of the older patients with a new diagnosis of HIV presented with a CD4 count < 200, or an AIDS-defining illness. Though not statistically significant, this same group also had a delay to viral suppression with only 59% achieving viral suppression after 12-weeks of cART initiation. Conclusions This study suggests that older patients are presenting to care with advanced stages of HIV, and may also have a delay in achieving viral suppression after cART initiation. Future studies should aim to target HIV testing and treatment strategies for this at-risk older adult group.

Poor HIV-Related Outcomes in Older Adults Newly Diagnosed With HIV: A 4-Year Retrospective Analysis From a Single Site in Asia

“…In our center, among the largest HIV treatment facilities in the nation's capital, we recorded significantly increasing annual trend in HIV diagnosis in older adults between 2016 and 2019. Older individuals were significantly more likely to present late with more advanced HIV disease compared with younger adults, as previously reported, 12,15 and this was complicated by significantly higher rates of chronic comorbidities and polypharmacy. Demographics, socioeconomic characteristics, and risk behaviors differed significantly between younger and older individuals with the latter associated with an overrepresentation of ethnic Indians, lower education levels, being married, and acquiring HIV through heterosexual contact.…”

“…Despite high rates of engagement with health facilities for the management of other chronic comorbidities, 14 they are more likely to present late with more advanced HIV disease compared with individuals diagnosed at younger ages. 12,15 In addition, short-term mortality following presentation to care is also higher in older adults compared with younger adults, independent of treatment. 13 Older adults have low or inconsistent condom use and poor knowledge of other forms of HIV prevention like preexposure prophylaxis (PrEP).…”

Late cART Initiation Consistently Driven by Late HIV Presentation: A Multicenter Retrospective Cohort Study in Taiwan from 2009 to 2019

“…Therefore, implementing measures to further expand targeted HIV testing is critical not only for typical sexually at-risk populations but also for neglected at-risk populations, such as older individuals. Older populations have been associated with LP [ 47 , 49 , 50 ], probably due to changes in risk-related behaviors (i.e., decreased condom use), a lower perception of HIV risk [ 51 , 52 ], the presence of multiple comorbidities [ 53 ], and an underestimation of the risk of HIV transmission behavior [ 53 ]. Additional strategies to mitigate the fear of the negative social consequences of HIV infection, such as discrimination and stigmatization, can also help increase people’s engagement in aVCT [ 43 ].…”

Long‐term success for people living with HIV: A framework to guide practice

“…The ability to identify, diagnose, and treat HIV has markedly improved, enabling more people living with HIV to achieve life expectancy similar to that of the general population [1, 2]. However, as explored in our previous article, people living with HIV are exposed to an excess risk of age‐related comorbidities [3], which can be exacerbated by late diagnoses [4] and can influence mental health [5] and physical functioning [6]. In addition, perennial societal and structural issues, including stigmatization [7], poverty [8], syndemics [9], and social isolation [10], continue to threaten the quality of life (QoL) of people living with HIV.…”