Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Instagram
  • Listen to CMAJ podcasts
Practice

HIV diagnosed after 50 years of age

Jacqueline M. McMillan, Leah H. Rubin and M. John Gill
CMAJ March 09, 2020 192 (10) E255; DOI: https://doi.org/10.1503/cmaj.191677
Jacqueline M. McMillan
Department of Medicine (McMillan, Gill), University of Calgary, Calgary, Alta.; School of Medicine (Rubin), Johns Hopkins University, Baltimore, Md.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Leah H. Rubin
Department of Medicine (McMillan, Gill), University of Calgary, Calgary, Alta.; School of Medicine (Rubin), Johns Hopkins University, Baltimore, Md.
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
M. John Gill
Department of Medicine (McMillan, Gill), University of Calgary, Calgary, Alta.; School of Medicine (Rubin), Johns Hopkins University, Baltimore, Md.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

In 2017, 22.9% of new HIV diagnoses in Canada were in people aged 50 years and older1

Similar rates of new diagnoses were reported in the United States in 2017 (17.1%) and in Europe in 2015 (17.3%).2 Screening for HIV is disproportionately low in adults 50 years and older, with a screening rate of only 25% in the US in 2009.3 This is likely because older adults perceive that they are at low or no risk for HIV exposure.3 According to the Public Health Agency of Canada’s HIV Screening and Testing Guide (https://www.canada.ca/en/public-health/services/hiv-aids/hiv-screening-testing-guide.html#c1), individuals who are/have been sexually active and have never been tested for HIV should be tested at least once.

Older adults report different sexual behaviours leading to differential HIV risk than younger individuals

Older adults in the largest risk category for HIV are those who have heterosexual sex (42%–48%), whereas younger adults in the largest risk category are men who have sex with men (38%–45%).2,4

The reason for HIV testing often differs by age

One study reported 70% of new diagnoses in people aged 50 years and older occurred in hospital compared with 42% in people aged 18–49 years.4 Another study reported that in more than half of people aged 50 and older screening was performed solely on the recommendation of a health care provider.3

At diagnosis, the CD4 T-cell count is lower in older than in younger adults (median 0.097–0.24 v. 0.307–0.394 × 109/L [97–240 v. 307–394 cells/μL])2,4

In one study, 70% of individuals aged 50 or older at diagnosis had concurrent AIDS.4 In the same study, older age was associated with a threefold increase in odds of late HIV diagnosis, defined as CD4 T-cell count < 0.2 × 109/L (< 200 cells/μL) or AIDS-defining illness.4

Older adults are more likely to adhere to HIV treatment than younger adults once antiretroviral therapy is initiated5

More frequent HIV screening will enable earlier diagnosis and, consequently, earlier initiation of treatment. As the HIV population ages, providers should also screen for and manage age-related comorbidities.

Footnotes

  • Competing interests: In last 3 years M. John Gill has served or been asked to serve as an ad hoc member of the national HIV advisory boards of Merck, Gilead and ViiV. No other competing interests were declared.

  • This article has been peer reviewed.

References

  1. ↵
    1. Haddad N,
    2. Li J,
    3. Totten S,
    4. et al
    . HIV in Canada — surveillance report, 2017. Can Commun Dis Rep 2018;44:348–56.
    OpenUrl
  2. ↵
    1. Tayoschi TDJ,
    2. Pharris A
    . New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004–15: an analysis of surveillance data. Lancet HIV 2017;4:e514–21.
    OpenUrl
  3. ↵
    1. Adekeye OA,
    2. Heiman HJ,
    3. Onyeabor OS,
    4. et al
    . The new invincibles: HIV screening among older adults in the US. PLoS One 2012;7:e43618.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Ellman TM,
    2. Sexton ME,
    3. Warshafsky D,
    4. et al
    . A forgotten population: older adults with newly diagnosed HIV. AIDS Patient Care STDS 2014;28:530–6.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Ghidei L,
    2. Simone MJ,
    3. Salow MJ,
    4. et al
    . Aging, antiretrovirals, and adherence: a meta analysis of adherence among older HIV-infected individuals. Drugs Aging 2013;30:809–19.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 192 (10)
CMAJ
Vol. 192, Issue 10
9 Mar 2020
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
HIV diagnosed after 50 years of age
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
HIV diagnosed after 50 years of age
Jacqueline M. McMillan, Leah H. Rubin, M. John Gill
CMAJ Mar 2020, 192 (10) E255; DOI: 10.1503/cmaj.191677

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
HIV diagnosed after 50 years of age
Jacqueline M. McMillan, Leah H. Rubin, M. John Gill
CMAJ Mar 2020, 192 (10) E255; DOI: 10.1503/cmaj.191677
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • In 2017, 22.9% of new HIV diagnoses in Canada were in people aged 50 years and older1
    • Older adults report different sexual behaviours leading to differential HIV risk than younger individuals
    • The reason for HIV testing often differs by age
    • At diagnosis, the CD4 T-cell count is lower in older than in younger adults (median 0.097–0.24 v. 0.307–0.394 × 109/L [97–240 v. 307–394 cells/μL])2,4
    • Older adults are more likely to adhere to HIV treatment than younger adults once antiretroviral therapy is initiated5
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • SARS-CoV-2 vaccination in pregnancy
  • Infantile perianal pyramidal protrusion
  • Topical nonsteroidal anti-inflammatory drugs
Show more Practice

Similar Articles

Collections

  • Topics
    • HIV & AIDS
    • Infectious diseases
    • Screening & diagnostic tests
    • Sexually transmitted infections

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected]

CMA Civility, Accessibility, Privacy

 

Powered by HighWire