Background
Increased survival has changed the age distribution of people with HIV in the United States (U.S.). Over 2010-2022, the fraction of people with diagnosed HIV (PWDH) aged > 50 years increased to 54%. Forecasts of future age distributions are needed to inform resource planning.
Methods
We used a life table model with age-specific mortality to predict future age distributions of PWDH in the U.S. by age from 2021-2030 and 2021-2040 under multiple scenarios by varying annual percentage changes (APC) in HIV diagnoses (Dx) and PWDH mortality rates (MR). National HIV Surveillance System data provided the number of PWDH aged ≥ 13 years at year-end 2020, HIV Dx in 2021, and PWDH deaths in 2021; and 2021 U.S. Life Tables provided population-based mortality estimates. We report estimated age distributions of PWDH (overall and by race/ethnicity) from 2021 (n = 1,053,300) to 2030 for two scenarios: A) held APC in Dx at -3% (proximate pre-COVID trend) with stable MR (0% change); and B) set APC in Dx to -22.3% to reach the Ending the HIV Epidemic (EHE) goal of 90% decrease in Dx by 2030 (from 2017 EHE baseline), and reduced MR linearly each year to reach the general population MR in 2030. For 2021-2040, we used the same values for Scenario A. For Scenario B we set APC in Dx at -11.2% to reach the 90% decrease in Dx by 2040, and linearly decreased MR to reach the general population MR by 2040.
Results
By 2030, Scenario A estimates there will be 1,116,600 PWDH; 57% (n = 640,100) aged > 50 years and 27% aged > 65 years. Under Scenario B, there will be 1,016,800 PWDH in 2030; 64% aged > 50 years and 31% aged > 65 years. By 2040, Scenario A estimates there will be 1,057,500 PWDH; 64% aged > 50 years and 33% aged > 65 years. Under Scenario B, there will be 929,800 PWDH in 2040; 75% aged > 50 years and 42% aged > 65 years (Fig 1). Scenario B also predicts 354,300 Black/African American (38%), 250,600 Hispanic/Latino (27%), and 245,500 White (26%) PWDH in the U.S. by 2040, with 70%, 73% and 82% of each group, respectively, aged ≥ 50 years.
Conclusions
If rates of decline in Dx and PWDH MR remain stable, by 2030 the absolute number of PWDH in the U.S. will increase, with 57% aged ≥ 50 years. Greater decreases in Dx with reduced MR decreases the absolute number of PWDH by 2040, but the fraction aged ≥ 50 years could increase to > 70%. Demand for aging-related resources will be especially needed to care for more and older PWDH in coming years, including Black/African American and Hispanic/Latino PWDH.