New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004–15: an analysis of surveillance data

Tavoschi, Lara; Gomes Dias, Joana; Pharris, Anastasia; on behalf of the show EU/EEA HIV Surveillance Network

http://hdl.handle.net/10400.18/4794

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Authors

Tavoschi, Lara

Gomes Dias, Joana

Pharris, Anastasia

on behalf of the show EU/EEA HIV Surveillance Network

Abstract(s)

Background: The HIV burden is increasing in older adults in the European Union (EU) and European Economic Area (EEA). We investigated factors associated with HIV diagnosis in older adults in the 31 EU/EEA countries during a 12 year period. Methods: In this analysis of surveillance data, we compared data from older people (aged ≥50 years) with those from younger people (aged 15–49 years). We extracted new HIV diagnoses reported to the European Surveillance System between Jan 1, 2004, and Dec 31, 2015, and stratified them by age, sex, migration status, transmission route, and CD4 cell count. We defined late diagnosis as CD4 count of less than 350 cells per μL at diagnosis and diagnosis with advanced HIV disease as less than 200 cells per μL. We compared the two age groups with the χ² test for difference, and used linear regression analysis to assess temporal trends. Findings: During the study period 54 102 new HIV diagnoses were reported in older adults. The average notification rate of new diagnoses was 2·6 per 100 000 population across the whole 12 year period, which significantly increased over time (annual average change [AAC] 2·1%, 95% CI 1·1–3·1; p=0·0009). Notification rates for new HIV diagnoses in older adults increased significantly in 16 countries in 2004–15, clustering in central and eastern EU/EEA countries. In 2015, compared with younger adults, older individuals were more likely to originate from the reporting country, to have acquired HIV via heterosexual contact, and to present late (p<0·0001 for all comparisons). HIV diagnoses increased significantly over time among older men (AAC 2·2%, 95% CI 1·2–3·3; p=0·0006), women (1·3%, 0·2–2·4; p=0·025), men who have sex with men (5·8%, 4·3–7·5; p<0·0001), and injecting drug users (7·4%, 4·8–10·2; p<0·0001). Interpretation: Our findings suggest that there is a compelling need to deliver more targeted testing interventions for older adults and the general adult population, such as by increasing awareness among health-care workers and expanding opportunities for provider-initiated and indicator-condition-guided testing programmes.

Description

EU/EEA HIV Surveillance Network: Daniela Schmid, André Sasse, Dominique Van Beckhoven, Tonka Varleva, Tatjana Nemeth Blazic, Linos Hadjihannas, Maria Koliou, Marek Maly, Susan Cowan, Kristi Rüütel, Kirsi Liitsola, Mika Salminen, Françoise Cazein, Josiane Pillonel, Florence Lot, Barbara Gunsenheimer-Bartmeyer, Stavros Patrinos, Dimitra Paraskeva, Maria Dudas, Haraldur Briem, Gudrun Sigmundsdottir, Derval Igoe, Kate O'Donnell, Darina O'Flanagan, Barbara Suligoi, Šarlote Konova, Sabine Erne, Irma Caplinskiene, Aurélie Fischer, Jackie Maistre Melillo, Tanya Melillo, Eline Op de Coul, Hans Blystad, Magdalena Rosinska, Isabel Aldir, Helena Cortes Martins, Mariana Mardarescu, Peter Truska, Irena Klavs, Asunción Díaz, Maria Axelsson, Valerie Delpech
Helena Cortes Martins: Departamento de Doenças Infeciosas do Instituto Nacional de Saúde Doutor Ricardo Jorge.