Trends in proportion of older HIV-infected people in care in Latin America and the Caribbean: a growing challenge

Abstract

We aimed to quantify the proportion of people receiving care for HIV-infection that are 50 years or older (older HIV patients) in Latin America and the Caribbean between 2000 and 2015 and to estimate the contribution to the growth of this population of people enrolled before (<50yo) and after 50 years old (yo) (⩾50yo). We used a series of repeated, cross-sectional measurements over time in the Caribbean, Central and South American network (CCASAnet) cohort. We estimated the percentage of patients retained in care each year that were older HIV patients. For every calendar year, we divided patients into two groups: those who enrolled before age 50 and after age 50. We used logistic regression models to estimate the change in the proportion of older HIV patients between 2000 and 2015. The percentage of CCASAnet HIV patients over 50 years had a threefold increase (8% to 24%) between 2000 and 2015. Most of the growth of this population can be explained by the increasing proportion of people that enrolled before 50 years and aged in care. These changes will impact needs of care for people living with HIV, due to multiple comorbidities and high risk of disability associated with aging.

Healthcare Resources Use in Patients with Human Immunodeficiency Virus (HIV). Real-World Evidence From Six Italian Local Health Units

“…Several studies have provided evidence that PLWHIV with ageing-associated comorbidities may require additional pharmacologic interventions that can complicate therapeutic management [24][25][26][27]. Consistent with findings reported in the literature [9,22,28,29] older PLWHIV are taking more medications to treat comorbidities than younger PLWHIV, or similarly-aged HIV-uninfected patients.…”

Prevalence and epidemiological characteristics of human immunodeficiency virus-1 infection in an iron mining area with intense migratory flow in Pará State, Brazilian amazon, 2005–2014

“…Infection was also observed in men > 50 years of age. This has also been observed by the Brazil Ministry of Health [12,13], and likely involves several factors, such as increased life expectancy, improved quality of life, and extent of sexual activity in these age groups due to new medicines used to treat erectile dysfunction. Young people aged 15-24 years account for approximately one third of new HIV infections.…”

The HIV epidemic in Latin America

“…With successful ART, many people living with HIV (PLWH) around the globe are experiencing decreased AIDS-related morbidity and mortality, thus living longer [18,19]. It is expected that by 2020 all low-income and middle-income countries will have adopted WHO's ‘Treat All’ policy; however, as of mid-2018, a few countries in Latin America still apply immunologic criteria for ART treatment initiation (Guatemala, El Salvador, Nicaragua, and Colombia, though Guatemala and Nicaragua plan to implement Treat All ART recommendation in 2018–2020) [2].…”