Poor HIV-Related Outcomes In Older Adults Newly Diagnosed with HIV: A Four-Year Retrospective Analysis from A Single Site in Asia.

Abstract

In resources limited settings, HIV-related services are often targeted to younger key populations though increasing reports have found adults ≥50 years now account for among the highest increase in new HIV diagnosis. We assessed the proportion of new HIV infections among older adults (≥50 years) and compared their socio-demographics, risk behaviours and HIV-related outcomes to newly diagnosed younger adults (<50 years). This retrospective analysis included all new HIV diagnosis from 2016-2019 at University of Malaya Medical Centre, Malaysia. Trends of HIV diagnosis was assessed using joinpoint regression analysis and characteristics between the older and younger adults were compared using χ2 test or Mann-Whitney U test. Kaplan-Meier analysis and log-rank test were used to compare the survival probability in both age groups. From a total of 594 new HIV diagnosis between 2016-2019, 11.5% (N=68) were among older adults with an annual percent increase of 5.50%. Older adults were more likely ethnic Indians (p<0.001), acquired HIV via heterosexual contact (p=0.001), had late presentation to care (p=0.003), and multimorbidity (p<0.001). Immunological responses after 12 months on ART were comparable in both groups. Older adults had a higher probability of death compared to younger adults (aHR 1.81, 95% CI 1.02-3.23, p=0.043) after adjusting for sex, mode of HIV transmission, late presentation to care, ART initiation and multimorbidity. Older adults diagnosed with HIV were associated with late care presentation and increased mortality. There is an urgent need to enhance uptake of HIV testing and linkage to care among older individuals in our setting.