As the Epidemic Ages, So Do the Patients

August 1, 2013

As the Epidemic Ages, So Do the Patients

Paul E. Sax, MD reviewing O'Keefe KJ et al. AIDS Care . Paul E. Sax, MD

The majority of people living with AIDS in San Francisco are now 50 or older.

An inevitable consequence of the decline in HIV-related deaths is the aging of the population living with HIV infection.

A recent study from San Francisco — a city hit particularly hard by HIV right from the start — documents this trend. Using surveillance data from city's HIV/AIDS surveillance registry, investigators charted the ages of individuals living with a diagnosis of AIDS, using the 1992 CDC case definition. This registry is updated through linkage to local and national databases that track deaths and other vital statistics. The researchers also compared the numbers for San Francisco with those for the U.S. overall.

Of the 9796 individuals living with AIDS in San Francisco at the end of 2010, 5112 (52%) were 50 or older. The proportion of those 50 or older has increased steadily since 1990, when only 10% were in this category, compared with 24% in 2000 and 38% in 2005. Nationally, the proportion has also increased, although not to the same degree: 20% of AIDS patients in the U.S. were 50 or older in 2001 compared with 39% in 2009.

Comment
Oliver Wendell Holmes reportedly once said, “Old age is 15 years older than I am,” but in HIV research, it has repeatedly been defined as older than 50 — perhaps a response to the early days of the epidemic, which predominantly involved young men and women. Although, as the study authors note, San Francisco is the first city to reach the milestone of more than 50% of AIDS patients being at least 50 years old, these data will resonate with HIV clinicians around the country, who are all experiencing the aging of their patient populations.

Using AIDS diagnoses increases the accuracy of the surveillance data, but it is also a limitation of this study: Only individuals with advanced immunosuppression were included, rather than everyone living with HIV infection.

Editor Disclosures at Time of Publication Disclosures for Paul E. Sax, MD at time of publication Consultant / Advisory board Bristol-Myers Squibb; Gilead; GlaxoSmithKline; Janssen; Merck Grant / research support NIH; Bristol-Myers Squibb; Gilead; GlaxoSmithKline; Merck Editorial boards Medscape; UpToDate Leadership positions in professional societies Mass ID Society (Vice President)

Citation(s): O'Keefe KJ et al. People fifty years or older now account for the majority of AIDS cases in San Francisco, California, 2010. AIDS Care 2013 Jan 15; [e-pub ahead of print].
( http://dx.doi.org/10.1080/09540121.2012.752565 ) -

Source - http://www.jwatch.org/na31802/2013/08/01/epidemic-ages-so-do-patients