Longitudinal Trends in HIV/AIDS Adults aged over 60 Years: A Multidimensional Decomposition with Global and Regional Comparisons, 1990-2021

Antiretroviral therapy has extended the lifespan of HIV/ADIS. However, research and policies mainly target younger groups, leaving gaps in the care for aging people living with HIV (PLHIV). Using data from the 2021 Global Burden of Disease Study, this research evaluated the global, regional, and national burdens of HIV/AIDS in adults aged 60 and above from 1990 to 2021. Key metrics were analyzed, and trends were predicted through various regression methods. Decomposition analysis identified the drivers of burden changes. Bayesian Age-Period-Cohort (BAPC) model predicted the global HIV/AIDS incidence, prevalence and mortality rate will rise across older aged groups, with an increasing absolute number of cases from 2022 to 2035. Among those over 60, absolute cases grew despite a -2.48 % EAPC. Age-standardized prevalence rate (ASPR) and age-standardized mortality rate (ASMR) rose by 580.76 % and 102.44 % respectively, with EAPCs of 5.32 and 0.22. Those aged 60-69 made up over 50 % of cases, with males being dominant. Temporal trends indicated a general decline in age-standardized incidence rate (ASIR) and ASMR but a sharp rise in ASPR between 1990 and 2021. The total APC was -0.16 for ASIR, 0.102 for ASMR, and 9.62 for ASPR. Although ASIR remained low in high SDI regions, it showed a modest increase with EAPC of 2.33, indicating a slow but steady rise in new infections. Mortality and Disability-adjusted life years (DALYs) cases in high-middle and middle SDI regions increased by 2-8 folds, with EAPCs from 3.33 to 5.32, indicating a growing disease burden. Population growth was the dominant driver of rising incidence and mortality. The growing HIV/AIDS burden among older adults underscores the dual challenges of aging and demographic shifts over the past 30 years. The increasing prevalence, mortality, and DALYs in aging populations underscore the urgent need for age-responsive HIV/AIDS strategies.