A large number of older patients are being diagnosed with HIV, and are being diagnosed later in the disease due to a lack of testing and stigma about sexuality.
A new study tracking diagnoses of HIV infection among older patients in 31 European countries showed that the number of infections is increasing, and more targeted interventions are needed.
The study was based on 12 years of data and was conducted by researchers from the European Centre for Disease Prevention and Control (ECDC).
Lara Tavoschi, PhD, science officer for HIV/AIDs and bloodborne infections at ECDC, told MD Magazine that the study shows that the healthcare community needs to do a better job of adjusting testing and treatment to follow where the HIV epidemic is leading.
“Our study shows the need to ensure all ages are appropriately targeted by sexual health services,” she said. “According to the literature review we have performed alongside the surveillance data analysis, sexuality is generally stigmatized in this age group, and that also healthcare providers may not perceive older adults as a population in need of HIV testing services.”
Overall, 54,102 new cases of HIV were reported in the 31 countries among adults 50 and older between 2004 and 2015. On average, that translated to 2.6 new diagnoses per 100,000 people each year of the study. However, the researchers said diagnosis rates increased over the surveillance period, with an average annual increase of 2.1%.
Tavoschi said it’s not known whether the increase in diagnoses can be attributed to an increase in actual infection rates or simply to better reporting and diagnosis.
“Data on the number of tests performed are collected annually through the European Surveillance System and reported in the annual surveillance report, nevertheless, the lack of a standard approach in collection methods across the [European Union and the European Economic Area] hinders the ability to perform comparative or longitudinal analyses,” she said.
In addition to the overall numbers, the study found the HIV population among older Europeans was different in some key ways from the younger HIV population.
The study found, for instance, that older Europeans were more likely than young people to contract the disease via heterosexual sex. They were also more likely to be diagnosed in their home country. Lastly, older Europeans were more likely to be diagnosed late, which Tavoschi said was one of the most striking findings.
“Despite increasing evidence of the benefits of early treatment for the infected individual, 47% of newly reported HIV cases overall, and 63% of cases in older adults with information on CD4 cell count are diagnosed as late presenters or with indication of advanced infection, i.e. the immune system is already starting to fail,” she said. “This suggests persistent problems with access to, and uptake of, HIV testing and counseling in many countries.”
What’s also notable is that the lack of testing doesn’t appear to be the result of patient reticence, but rather a lack of being asked to take a test. Tavoschi said other published studies have shown older patients are likely to accept an offer of an HIV test, particularly from their general practitioner or in an emergency setting. In general, older patients appear to view testing as a welcome prevention effort.
“This, coupled with several case reports of older adults not being diagnosed with HIV after several visits to health care providers, indicates the importance of tackling missed opportunities for testing in the health care setting,” she said.
She said doctors should help older patients by initiating conversations about sexual risks, and by presenting HIV tests in a casual way, something the patient has a choice about, as a way to lessen stigma and make such testing feel more routine.
The study, titled “New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004—15: an analysis of surveillance data,” was published in late September in The Lancet HIV.