Wong Hoi Yee, Wong Pui Li, Bador Maria Kahar, Chong Meng Li, Shenoi Sheela, Rozanova Julia, Syed Omar Sharifah Faridah, Neelamegam Malinee, Lee Yew Kong, Rajasuriar Reena
Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.
J Acquir Immune Defic Syndr. 2023 May 1;93(1):64-72. doi: 10.1097/QAI.0000000000003169.
In resource-limited settings, HIV-related services are often targeted to younger key populations, although increasing reports have found that 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 sociodemographics, risk behaviors, and HIV-related outcomes to newly diagnosed younger adults (<50 years).
This retrospective analysis included all new HIV diagnosis from 2016 to 2019 at the University of Malaya Medical Centre, Malaysia. Trends of HIV diagnosis was assessed using join point regression analysis, and characteristics between the older and younger adults were compared using χ 2 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 and 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 through heterosexual contact ( P = 0.001), had late presentation to care ( P = 0.003), and multimorbidity ( P < 0.001). Immunological responses after 12 months on antiretroviral therapy were comparable in both the groups. Older adults had a higher probability of death compared with younger adults (adjusted hazard ratio 1.81, 95% confidence interval: 1.02 to 3.23, P = 0.043) after adjusting for sex, mode of HIV transmission, late presentation to care, antiretroviral therapy 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.
在资源有限的环境中，与艾滋病毒相关的服务通常针对年轻的关键人群，尽管越来越多的报告发现，50岁及以上的成年人现在是新艾滋病毒诊断增加最多的人群之一。我们评估了老年人（≥50岁）中新发艾滋病毒感染的比例，并将他们的社会人口统计学、风险行为以及与艾滋病毒相关的结果与新诊断的年轻成年人（<50岁）进行比较。
这项回顾性分析纳入了2016年至2019年在马来西亚马来亚大学医学中心所有新的艾滋病毒诊断病例。使用连接点回归分析评估艾滋病毒诊断趋势，使用χ²检验或曼-惠特尼U检验比较老年人和年轻人的特征。采用Kaplan-Meier分析和对数秩检验比较两个年龄组的生存概率。
在2016年至2019年期间的594例新艾滋病毒诊断病例中，11.5%（N = 68）为老年人，年增长率为5.50%。老年人更可能是印度裔（P < 0.001），通过异性接触感染艾滋病毒（P = 0.001），就诊延迟（P = 0.003），且患有多种疾病（P < 0.001）。两组在接受抗逆转录病毒治疗12个月后的免疫反应相当。在调整了性别、艾滋病毒传播方式、就诊延迟、抗逆转录病毒治疗开始时间和多种疾病后，老年人死亡的概率高于年轻人（调整后的风险比为1.81，95%置信区间：1.02至3.23，P = 0.043）。
被诊断感染艾滋病毒的老年人与就诊延迟和死亡率增加有关。在我们的环境中，迫切需要提高老年人对艾滋病毒检测的接受度以及与护理的联系。
