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• W2892674098 abstract "To the Editors: Since the emergence of antiretroviral therapy (ART), there has been a continuous reduction in mortality due to AIDS-related complications among people living with HIV (PLHIV).1,2 With high coverage of ART in most high-income countries, PLHIV are now able to live longer lives, resulting in an increasing population of PLHIV aged 50 years and above.3–6 Over the past 10 years, the global proportion of PLHIV on ART has increased from ∼12% to ∼46%.7 Older PLHIV, aged ≥50 years, present a unique population that requires special care and consideration due to poorer immunological response to ART and a greater risk of death.8–10 In general, older age is associated with greater multimorbidity, which impacts quality of life and increases the risk of mortality.11 HIV infection in older PLHIV further contributes to this burden such that a longer duration of infection is associated with a higher risk of multimorbidity.12–14 Older PLHIV are reported to exhibit more cardiovascular, pulmonary, and malignant diseases compared with those without HIV, higher antiretroviral toxicities compared with younger PLDHIV, and excessive immune activity and inflammation compared with HIV-negative individuals.14 Given these complications and the general medical care required for aging population, it is important to understand the current and future age and sex distribution of diagnosed PLHIV to inform service delivery planning. In Australia, modeling conducted in 2009 showed the average age of HIV-positive men in Australia (which make up 87% of PLHIV in the country) would increase by a year every 2 calendar years from the 1985 to 2005.15 Since 2012, Australia has experienced a rapid scale-up of ART for treatment as prevention, and since 2016, access to pre-exposure prophylaxis (PrEP) has expanded as part of the New South Wales (NSW) HIV strategy 2016–2020 to push for a significant reduction in new HIV diagnoses.16–19 It is yet to be explored how this affects the number and age distribution of new HIV in the country. It is therefore important to provide updated estimates of diagnosed PLHIV by age and sex, as well as to project the likely changes in the number of diagnosed PLHIV over the next 10 years. MATERIALS AND METHODS The number and proportion of diagnosed PLHIV were estimated in 5-year age groups from the start of the Australian epidemic in 1980–2017. Estimates were based on HIV notifications data obtained from the Australian national HIV/AIDS registry.16 We adjusted the number of diagnosed PLHIV in each age group for duplicates due to incomplete recording of name codes in the registry in the early stages using a previously developed statistical method based on date of birth.20 This method was applied for men and women separately. We then adjusted the number of diagnosed PLHIV in each age group according to aging, annual emigration, and mortality. Emigration rates were estimated using overall population movement data from the Australian Bureau of Statistics and follow-up data of people recently diagnosed with HIV in NSW.21 Meanwhile, overall mortality rates for diagnosed PLHIV were obtained from the Australian HIV Observational Database. These were adjusted for age using mortality data per 5-year age groups obtained from the Australian Bureau of Statistics.22 Full details of the HIV notifications data, deduplication process, and emigration and mortality rates are available from Australia's Annual Surveillance Report.16 We then projected the number and proportion of diagnosed PLHIV in each 5-year age group from 2018 to 2027 under 3 scenarios for the annual number of HIV notifications: first, we assumed a continuation of the linear trend in notifications over 2013–2017; second, we assumed a 35% reduction in overall HIV notifications in the next decade because of the scale-up of PrEP and the effects of HIV treatment as prevention based on an existing model on reducing HIV incidence in Australia23; and third, we assumed a 50% reduction in overall HIV notifications in the next decade because of the scale-up of PrEP and HIV treatment (representing an optimistic reduction scenario). For each scenario, similar changes were applied across all age groups, and in both men and women. The average age of diagnosed PLHIV was calculated by taking the mean per age bracket and dividing it with the total number of diagnosed PLHIV (Fig. 1).FIGURE 1.: Estimated number of diagnosed men and women in Australia over 1986–2026 by 5-year age bin (under the linear projection scenario).RESULTS AND DISCUSSION We estimated a 58% increase in the total number of diagnosed PLHIV increased over the past decade from 15,507 in 2007 to 24,646 in 2017. The number of HIV-diagnosed men increased by 55% from 14,029 in 2007 to 21,677 in 2017, whereas the number of HIV-diagnosed women nearly doubled by 85% from 1581 in 2007 to 2920 in 2017 (Fig. 1). This increase in women is partly due to a stable number of female notifications each year.16 The average age of diagnosed PLHIV in Australia has increased from 45 years in 2007 to 49 years in 2017 highlighting an ageing population of Australians living with diagnosed HIV. Considering sex differences, the average age of diagnosed male PLHIV has increased from 45 years in 2007 to 49 years in 2017, whereas the average age of diagnosed female PLHIV has increased from 40 years in 2007 to 44 years in 2017. These increases in age are primarily because of reduced mortality through ART, as the average age of diagnosis has remained at 38 years (39 years in men and from 35 years to 37 years in women) over this period. Simulations show that the total number of diagnosed PLHIV in Australia will increase by 38% from 24,646 in 2017 to 34,095 in 2027 if the current trend in annual notifications continues. Assuming annual notifications decline by 35%, the number of diagnosed PLHIV is estimated to reach 31,993 in 2027 bringing down the number of diagnosed PLHIV by 6%. Moreover, assuming a decline in annual notifications of 65%, we estimated the number of PLHIV will reach 30,016 in 2027, bringing down the number of diagnosed PLHIV by 11%. By 2027, the highest proportion of diagnosed PLHIV will be in the 55–59 age group, and the average age of diagnosed people will be 52 years if the current trend in annual notifications continue, 53 years if annual notifications decline by 35%, and 54 years if annual notifications decline by 65%. CONCLUSIONS This study reveals an increase in the number of diagnosed PLHIV in Australia over the past decade. Results highlight an ageing population of PLHIV in the country, indicating the benefits of ART. However, simulations show that even if new infections are substantially reduced through interventions such as PrEP, there will only be a small reduction in the number of diagnosed PLHIV requiring ongoing care and treatment. These findings are important for future service provision planning because older diagnosed PLHIV require special care and treatment due to complications brought about by HIV, and ART." @default.
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• W2892674098 date "2018-12-15" @default.
• W2892674098 modified "2023-10-18" @default.
• W2892674098 title "Aging of the HIV Population in Australia: A Modeling Study" @default.
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