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.

Keywords: HIV epidemiology; ageing; demographic profile; life expectancy; modelling; time since treatment initiation.

Figure 1

Numbers and age distributions of adults aged ≥18 years living with diagnosed HIV (aPLdHIV) in 2018 and 2030, according to different scenarios. Numbers and age distributions for men (a) and for women (b), in 2018 (in red) and in 2030 (in turquoise) for scenario 1 (i.e. 30% decrease in newly diagnosed HIV cases between 2018 and 2030). Comparison of the numbers and age distributions of adults living with diagnosed HIV in 2030 for scenario 1 (in turquoise) and scenario 2 (i.e. status quo situation with a steady annual number of new HIV cases over 2019–2030, black diagonal stripes) for men (c) and for women (d), and for scenario 1 and scenario 3 (i.e. epidemic elimination with zero new HIV cases in 2030, black diagonal stripes) for men (e) and for women (f). Detailed assumptions made for the number and age of newly diagnosed HIV cases in 2019–2030 can be found in the Supplementary Material, Section C.

Figure 2

Numbers and age distributions of adults aged ≥18 years living with diagnosed HIV (aPLdHIV) in 2018 and 2030, stratified by time since ART initiation (in years): for men (a and b) and women (c and d) in 2018 (a and c) and in 2030 (b and d) for scenario 1 (i.e. 30% decrease in newly diagnosed HIV cases between 2018 and 2030). Results for other scenarios can be found in the Supplementary Material, Section I and Figures S4 and S5.