Projection of age of individuals living with HIV and time since ART initiation in 2030: estimates for France

Abstract

Introduction: Thanks to antiretroviral treatment (ART), people living with HIV (PLHIV) are living longer and ageing. However, ageing involves increased risks of co-morbidities, which also depend on when PLHIV individuals started ART. To tackle the HIV age-related upcoming challenges, knowledge of the current and future age structure of the HIV population is needed. Here, we forecast the demographic profile of the adult population living with diagnosed HIV (aPLdHIV) in France until 2030, accounting for the impact of the ART initiation period on mortality. Methods: We used national data from the French Hospital Database on HIV (ANRS CO4-FHDH) and a sample of the National Health Data System to, first, characterize the aPLdHIV in 2018 and estimate their mortality rates according to age, sex and ART initiation period. Second, we used national HIV surveillance data to define three scenarios for the numbers of newly diagnosed HIV cases over 2019-2030: 30% decrease in HIV cases (S1), status quo situation (S2) and epidemic elimination (S3). We then combined these data using a matrix model, to project the age structure of aPLdHIV and time since ART initiation. Results: In 2018, there was an estimated 161,125 aPLdHIV (33% women), of which 55% were aged 50 or older (50+), 22% aged 60+ and 8% aged 70+. In 2030, the aPLdHIV would grow to 195,246 for S1, 207,972 for S2 and 167,221 for S3. Whatever the scenario, in 2030, the estimated median time since ART initiation would increase and age distribution would shift towards older ages: with 65-72% aPLdHIV aged 50+, 42-48% 60+ and 17-19% 70+. This corresponds to ∼83,400 aPLdHIV (28% women) aged 60+, among which ∼69% started ART more than 20 years ago (i.e. before 2010) and ∼39% ≥30 years ago (i.e. before 2000), and to ∼33,100 aPLdHIV (27% women) aged 70+, among which ∼72% started ART ≥20 years ago and ∼43% ≥30 years ago. Conclusions: By 2030, in France, close to 20% of the aPLdHIV will be aged 70+, of which >40% would have started ART more than 30 years ago. These estimates are essential to adapt co-morbidities screening and anticipate resource provision in the aged care sector.

Updated mortality and causes of death in 2020-2021 in people living with HIV: a multicenter study in France

“…Aging has been confirmed at the national level: in 2018, in France, there was an estimated 160 000 PWH, of whom 55% were aged at least 50 years, 22% at least 60 years, and 8% at least 70 years [5]. Age is associated with chronic conditions such as NANH-related malignancies, cardiovascular, renal, liver, bone, and neurological diseases [5]. Nevertheless, in our survey, PWH were slightly older compared with the previous 2011-2015 survey, indicating a continuous renewal of the cohort with younger PWH between the two periods.…”

“…Aging has been confirmed at the national level: in 2018, in France, there was an estimated 160 000 PWH, of whom 55% were aged at least 50 years, 22% at least 60 years, and 8% at least 70 years [5]. Age is associated with chronic conditions such as NANH-related malignancies, cardiovascular, renal, liver, bone, and neurological diseases [5].…”

“…PWH now have a longer life expectancy [2], approaching that of the general population [3,4]. By 2030, almost 20% of PWH in France will be aged 70 years or over [5]. This demographic shift has led to a change in death causes [6], with an increase in non-AIDS-related mortality rates [7,8] due to age-related comorbidities [9].…”

Treatment Regimens and Care Models for Older Patients Living with HIV: Are We Doing Enough?

“…Many older adults with HIV have been living with HIV for over three decades, and projection data indicate that a growing proportion of PWH age 60 and over will have been taking ART for 30 years or more. 37 The newest HIV treatment medication to be approved for use is lenacapavir, a novel HIV capsid inhibitor with potent activity and a relatively long half-life administered as a sub-cutaneous injection and studied for use in individuals who are treatment-experienced with evidence of multi-drug resistant HIV. The median age of participants in the clinical trial informing the approval of lenacapavir was 52 years old (range 23–78), reflecting that highly treatment-experienced individuals tended to be over age 50.…”

Growing older with HIV in the Treat‐All Era

“…Central to the transformation of any health system are the data informing its evolution and adaptation. Marty et al utilized French national data to show that almost 20% of PWH will be >70 years of age by 2030, and 40% would have been on ART for >30 years [30]. By leveraging multiple research and surveillance resources, their team has provided evidence to guide local health systems to prepare for the levels of ageing-related care these PWH will require.…”