Projected Increases in Older People With HIV in the United States Through 2040

People with diagnosed HIV (PWDH) live longer but have increased co-morbidities than peers without HIV and premature ageing. In 2021, 54% of United States PWDH were aged ≥50 years. PWDH age distribution projections beyond 2030 are needed to plan future HIV and ageing care.

Our life table-based model used 2020-2021 Centers for Disease Control and Prevention National HIV Surveillance System data to project PWDH age distributions from 2021-2040 across three modeled scenarios, varying annual percentage change (APC) in HIV diagnoses (new infections proxy) and PWDH mortality rate.

The median age of PWDH increased from 51 years (2021) to 55-60 years (2040) when diagnoses decreased. Numbers of older PWDH increased across racial/ethnic groups and regions, regardless of decreasing or increasing diagnoses or reducing mortality. Reducing diagnoses 90% by 2040 with reduced mortality estimated 75% (695 912) of PWDH would be aged ≥50 years, 42% (388 639) aged ≥65 years, and 20% (190 600) aged ≥75 years. Extending -3% APC reductions in diagnoses projected 64% (670 977) aged ≥50 years, 33% (350 025) aged ≥65 years, and 16% (168 139) aged ≥75 years. Modestly increasing diagnoses projected 53% (761 194) aged ≥50 years, 26% (371 244) aged ≥65 years, and 12% (171 233) aged ≥75 years. Across scenarios, the number of PWDH aged ≥50, ≥65, and ≥75 years, respectively, increased 18%-34%, 144%-171%, and 565%-654%.

By 2040, the estimated number of older PWDH will increase substantially, regardless of decreasing or increasing HIV diagnoses. The healthcare sector must prepare now to ensure future ageing-related care needs of PWDH are met.