Projected Increases in Older People with HIV in the United States through 2040

Background People with diagnosed HIV (PWDH) live longer but have increased comorbidities than peers without HIV and premature aging. In 2021, 54% of United States PWDH were aged ≥50 years. PWDH age distribution projections beyond 2030 are needed to plan future HIV and aging care. Methods Our life-table-based model used 2020-2021 Centers for Disease Control and Prevention National HIV Surveillance System data to project PWDH age distributions from 2021-2040 across three modeled scenarios, varying annual percentage change (APC) in HIV diagnoses (new infections proxy) and PWDH mortality rate. Results The median age of PWDH increased from 51 years (2021) to 55-60 years (2040) when diagnoses decreased. Numbers of older PWDH increased across racial/ethnic groups and regions, regardless of decreasing or increasing diagnoses or reducing mortality. Reducing diagnoses 90% by 2040 with reduced mortality estimated 75% (695,912) of PWDH would be aged ≥50 years, 42% (388,639) aged ≥65 years, and 20% (190,600) aged ≥75 years. Extending -3% APC reductions in diagnoses projected 64% (670,977) aged ≥50 years, 33% (350,025) aged ≥65 years, and 16% (168,139) aged ≥75 years. Modestly increasing diagnoses projected 53% (761,194) aged ≥50 years, 26% (371,244) aged ≥65 years, and 12% (171,233) aged ≥75 years. Across scenarios, the number of PWDH aged ≥50, ≥65, and ≥75 years respectively increased 18%-34%, 144%-171%, and 565%-654%. Conclusion By 2040, the estimated number of older PWDH will increase substantially, regardless of decreasing or increasing HIV diagnoses. The healthcare sector must prepare now to ensure future aging-related care needs of PWDH are met.