Rise in late HIV diagnoses among over-50s across Europe
Calls to improve age-related intervention services as HIV burden increases among an older generation of adults in EU/EEA countries.
Increasing life expectancy and improvements in HIV treatment mean that we are beginning to see an ageing population of people living with HIV unfold, particularly in high-income countries such as those in Europe. However, HIV isn’t only affecting people who have been receiving treatment long-term, with evidence emerging that an increasing number of people aged 50 and over are now being diagnosed later in life – even though they may have acquired HIV much earlier.
A recent cross-country analysis from the European Centre for Disease Prevention and Control in Sweden has confirmed that one in six new cases of HIV are being diagnosed among adults over 50 years of age. Of the 29,419 new HIV diagnoses reported in 2015 in EU and EEA countries, 5,076 (17·3%) were among this age group at the time of their diagnosis.
Published in The Lancet, the study found that countries which saw the sharpest rise in new infections among their older generation over a 12-year period of investigation included a number of eastern European countries, Belgium, Germany, Norway, and the UK. The only country in Europe to see a decrease in new infections among the over 50 age group was Portugal.
When compared to a younger cohort of adults aged 15-49, researchers found that older individuals were more likely to have acquired HIV through heterosexual sex and to present late to care with much lower CD4 counts, indicating advanced disease.
The authors admitted that estimating the incidence of HIV among older people is challenging. A newly diagnosed infection could have occurred many years before symptoms arise or diagnosis is made. Older patients may have also have delayed medical testing because they did not perceive themselves to be at risk of HIV infection, or lacked knowledge about prevention and transmission risks.
The steady growth in new transmissions as a result of heterosexual sex is concerning, and suggests that much more needs to be done in promoting condom use and the initiation of HIV testing among an older generation of adults. But in order to achieve this, and to avoid patients being diagnosed late with advanced disease, the stereotype of asexuality among older adults must be challenged among healthcare providers.
Instead we are currently seeing many missed opportunities in prevention and testing initiatives across European healthcare systems, despite researchers finding that the most significant factor affecting testing take-up is the active offer of an HIV test by a service provider. As the authors highlight in their commentary, this is because the vulnerability of older people to HIV is often overlooked:
‘The perception of older adults as not being at risk is often shared by healthcare providers and society at large, and is influenced by age-related stigma’
Although HIV testing programmes are available across Europe, this new evidence suggests that additional focus must be placed on increasing age-related HIV awareness among healthcare workers. Furthermore, opportunities such as opt-out routine HIV testing in general practices, provider-initiated testing when immunodeficiency is present and targeted testing interventions for older adults must be expanded.