Trends in proportion of older HIV-infected people in care in Latin America and the Caribbean: a growing challenge

Abstract

We aimed to quantify the proportion of people receiving care for HIV-infection that are 50 years or older (older HIV patients) in Latin America and the Caribbean between 2000 and 2015 and to estimate the contribution to the growth of this population of people enrolled before (<50yo) and after 50 years old (yo) (⩾50yo). We used a series of repeated, cross-sectional measurements over time in the Caribbean, Central and South American network (CCASAnet) cohort. We estimated the percentage of patients retained in care each year that were older HIV patients. For every calendar year, we divided patients into two groups: those who enrolled before age 50 and after age 50. We used logistic regression models to estimate the change in the proportion of older HIV patients between 2000 and 2015. The percentage of CCASAnet HIV patients over 50 years had a threefold increase (8% to 24%) between 2000 and 2015. Most of the growth of this population can be explained by the increasing proportion of people that enrolled before 50 years and aged in care. These changes will impact needs of care for people living with HIV, due to multiple comorbidities and high risk of disability associated with aging.

Keywords: Aging; Caribbean; HIV/AIDS; Latin America; older.

Fig. 1.

(a) Percentage of HIV + patients older than 50 years actively receiving care by a group of age and calendar year and (b). The trend of percentage of patients older than 50 among active patients by site and calendar year. (a) Groups of age at enrolment were: (1) <50yo at enrolment and (2) ⩾50 at enrolment. In the <50yo at enrolment group we included active patients who enrolled in care with less than 50 years and aged to over 50 while in care (gray). In the ⩾50 at enrolment group, we included patients who enrolled in care at 50 years or older (blue + orange). Percentage of new patients enrolled older than 50 at each year are shown by the blue bar. (b) The increase in the percentage of patients older than 50 along time is statistically significant for each site (P-values for a test of tendency are <0.001 for each country and for the whole cohort). The curves are predictions from logistic models adjusted by year and site. The absolute number of all active patients, those who are older than 50 and their classification according to age at enrolment by year, are shown in the table; decreases in active patients from 2013 to 2015 were due to lack of available data from Haiti.