Background
Hearing loss (HL) and age-associated dementia (AAD) are prevalent and have considerable detrimental effects on quality of life; HL is a leading preventable risk factor for dementia worldwide. As persons with HIV (PWH) age, they are at particular risk for sensorineural HL and AAD. We used simulation modeling to estimate the prevalences of HL and AAD among PWH in the US over the next 10 years.
Methods
We developed the CHARMED microsimulation model of HIV and aging comorbidities in the US, including HL and AAD. We simulated a cohort of PWH engaged in HIV care and on ART at age 65 years throughout their remaining lifetimes. CHARMED includes HL prevalence at model start (28.5% for males, 12.2% for females) and age- and sex-specific annual probabilities of incident HL for persons without HL (0.1-10.4% [NHANES]). We incorporated incident AAD (0.3-10.8%) from the Adult Changes in Thought cohort. For PWH, we assumed no increased risk of HL to project conservative estimates, but included a 1.8-fold increased risk of dementia based on observational data from a Kaiser Permanente cohort. We estimated AAD incidence with and without the proportion attributable to HL by removing the estimated proportion attributable to HL (adjusted incidence risk ratio, 2.0 [95% CI, 1.5-2.8] calibrated from NHATS). For PWH, we adjusted lifetables to reflect this population’s sociodemographic characteristics. We projected age- and sex-stratified prevalences of HL and AAD, which we applied to model-projected numbers of PWH over age 65y across the next 10 years.
Results
From 2023-2033, the numbers of PWH aged 65y or older would increase substantially, and most would be living with HL, AAD, or both (Figure). By 2033, of PWH aged 65y or older in the US we project that 189,300 will be males and 63,100 will be females. Of 189,300 males, 75,700 will have HL alone, 9,700 will have AAD alone, and 32,900 will have both HL and AAD. Among 63,100 females, 17,700 will have HL alone, 3,400 will have AAD alone, and 7,400 will have both HL and AAD.
Conclusions
The number of PWH over 65y with HL and AAD in the US will increase substantially over the next decade. Prevention and treatment efforts, as well as increasing support services for the hearing impaired, potentially through programs like Ryan White, should become higher priorities.
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