Many clinicians tell concerning stories about older people being diagnosed with advanced HIV after undergoing extensive and extended workups for alternative causes at respected medical centers. While provider’s failure to consider HIV may explain some of the problem, we ask at time of HIV diagnosis: 1) Does HIV present differently among older compared with younger individuals? and 2) Among 60+ year old individuals, do conditions co-occurring at diagnosis differ from uninfected controls?
Using a previously validated algorithm requiring detectable HIV-1 RNA prior to ART initiation, we reviewed incident HIV diagnoses from 2010-2015 within the Veterans Healthcare System and compared with demographically matched uninfected controls. Electronic health record data including diagnostic codes and laboratory data were obtained from the national corporate data warehouse. AIDS defining illnesses were identified using validated ICD-9 codes and present if assigned within 1 year before or 6 months after a confirmed HIV diagnosis.
3000 incident HIV infections were matched to 5449 controls with complete data. Despite HIV+ diagnosed at 60+ years having been in care twice as long as HIV+ diagnosed under 40 years (5 vs. 10 years, p<0.001), those diagnosed at 60+ years were 1.5-2.4 times more likely to have advanced HIV disease indicated by AIDS defining conditions, CD4 count <200/ ml., or HIV-1 RNA>106 /ml (Table, p<0.001). Compared to HIV+ diagnosed when < 40 years of age, bacterial pneumonia, herpes zoster, anemia, lymphocytopenia, and thrombocytopenia were 2-3 times more common at diagnosis among HIV+ 60+ years. While these conditions also increased with age for controls, they remained 2-7 times more common among HIV+ than uninfected 60+ year olds.
At the time of diagnosis with HIV, older people present with more advanced disease than younger counterparts. Associated conditions including: pneumonia, herpes zoster, anemia, lymphocytopenia, and thrombocytopenia are more common among HIV+ at all ages, but increase with age among both HIV+ and controls which may contribute to the delay in HIV diagnosis.