CATIE News

4 August 2020 

Calgary doctors find that more older people are getting HIV

  • An Alberta study found a growing proportion of new HIV diagnoses are among people over 50
  • Older adults were more likely than younger people to be diagnosed as a result of illness
  • The findings suggest there may be missed opportunities for earlier testing among older adults

A striking feature from reports of early cases of AIDS in North America was the relative youth of hospitalized patients—usually men in their 20s and 30s. Although HIV infection would eventually broaden its spread to all age groups, its initial preponderance among young people may have inadvertently given the mistaken impression that older people are not susceptible to this virus.

A team of researchers in Southern Alberta has reviewed the age distribution of new diagnoses of HIV infection in that region. In an analysis of data collected over the past three decades, they found that proportionally more people over the age of 50 are becoming infected with HIV. In 1990, according to the researchers, 7% of new cases of HIV in Southern Alberta were in people over the age of 50, while in 2019 the figure rose to 18%.

The researchers stated that their study underscored the importance of ongoing discussion between doctors and patients about the need for regular HIV screening, particularly in people who are over the age of 50.

Study details

The Southern Alberta Clinic (SAC) in Calgary is a regional centre for the care and treatment of people with HIV. SAC has been collecting and analysing health-related information from HIV-positive people since the 1980s and has produced useful reports.

In their most recent analysis, researchers at SAC focused on new diagnoses of HIV infection in adults between October 1989 and December 2019.

The doctors divided people into the following two groups:

  • “younger” – people between the ages of 18 to 50
  • “older” – people over the age of 50

Results

A total of 1,899 new cases of local HIV infection were made during the study period.

Age

Although the distribution of new infections covered a broad age range—18 to 79 years—the average age at the time of diagnosis across the three-decade span of the study was 35 years. Most infections (85%) occurred among men. However, the distribution of new HIV diagnoses in people over the age of 50 increased markedly from 7% of new cases in 1990 to 18% in 2019.

Behaviours

The researchers stated that common “risk factors” for infection were distributed somewhat differently depending on a person’s age as follows:

Older people

  • condomless intercourse between men and women – 29%
  • condomless intercourse between men – 27%
  • condomless intercourse between men with other men or women – 21%

Younger people

  • condomless intercourse between men – 51%
  • condomless intercourse between men and women – 16%
  • heterosexually identified people who injected street drugs – 11%

Reasons for getting an HIV test

The doctors found that the main reasons for HIV testing differed between the study’s two age groups as follows:

Older people

  • illness – 47%
  • patient request – 19%
  • physician request – 14%

Younger people

  • patient request – 34%
  • illness – 29%
  • physician request – 17%

Ethno-racial groups

There were no differences in the distribution of new HIV test results by age group. The overall distribution of HIV infection by ethno-racial groups was as follows:

  • White – 73%
  • Black – 10%
  • Indigenous – 7%

Deaths

Proportionally, more older people diagnosed with HIV died (45%) than did younger people (33%).

The most common cause of death was related to AIDS—64% of younger people and 55% of older people.

Deaths due to trauma or substance use were lower in older people (5%) than in younger people (14%).

Bear in mind

1. The study doctors stated that “HIV testing may have been inadequate for this older population. It may also be the case that older adults, either consciously or unconsciously, avoid diagnostic HIV testing.” A U.S. survey of more than 12,000 people over the age of 50 found relatively low rates of HIV screening. A major reason for this low rate was the perception among 84% of participants that they were at low risk for exposure to this virus.

2. The doctors underscored that the reason for HIV testing in nearly half of older adults was that there was an illness (that likely suggested immunological dysfunction) followed by patient request (19%). That such a large proportion of people developed illness that prompted HIV testing “suggests that an opportunity for earlier diagnosis may have been missed,” the doctors stated. Studies in British Columbia and Milan, Italy, have found that among people who were diagnosed late in the course of HIV infection, there were usually missed opportunities for earlier HIV testing. These opportunities arose because people had sought medical care for serious illness five years prior to their eventual diagnosis with HIV. In the B.C. study, people over the age of 40 were at heightened risk for missed opportunities for HIV testing and in the Milan study people over the age of 60 were at heightened risk.

3. It is important to note that, in general, the immune system weakens with age. This growing weakness may be problematic for older people, particularly if they are diagnosed late in the course of HIV infection. Studies have found that people diagnosed late in the course of HIV infection are at elevated risk of dying within a year of diagnosis. Thus, regular HIV testing is likely useful. There are many treatment options for HIV infection today compared to 20 years ago. What’s more, treatments these days are well tolerated and highly effective.

4. The Calgary team found that more older people (42%) reported living alone compared to young people (33%). They noted that “loneliness and social isolation are increasingly recognized as factors leading to poor health outcomes, such as [death], depression and [poor cardiovascular health]. As increasing numbers of persons with HIV infection reach older age, the need for supportive housing and institutional living arrangements is likely to increase. This is an area in which research is imperative and must involve patients and [their families] who are among the key stakeholders.”

5. According to the doctors, HIV testing rates among older people “may be improved by education of both patients and clinicians about the growing proportion of older adults newly acquiring HIV infection, as well as adults aging with HIV infection.” They added that the purpose of education would be to “empower patients and clinicians to start a discussion around screening for HIV, as earlier screening leads to earlier initiation of treatment and improved outcomes.” The Calgary doctors call for more studies to help reduce the upward trend in new HIV infections among older people and to foster “more open dialogue with older adults around their sexual health and to address the unique aspects of care for older adults newly diagnosed with HIV infection.”

—Sean R. Hosein

Resources

Loneliness linked to poorer brain health and reduced quality of life in HIVCATIE News

The epidemiology of HIV in Canada – CATIE factsheet

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