Epidemiological, clinical and mortality trends in people with HIV over 60 years in the PISCIS population-based cohort from Catalonia and Balearic Islands

Objective: With HIV now a chronic condition and an aging population, understanding the evolving profiles of older people with HIV (PWH) is crucial. In this longitudinal study, we examined changes in epidemiological and mortality trends among aging PWH aged 60 and above from 1998 to 2021. Design: The study constructed four retrospective cohorts based on our calendar periods, reflecting the changing epidemiology of HIV – 1998–2003, 2004–2008, 2009–2014, and 2015–2021. Each calendar period included patients on follow-up that turned 60 during that period in PISCIS, the Populational HIV Cohort from Catalonia and Balearic Islands. Methods: Sociodemographic and clinical characteristics were analyzed and compared between periods, and 5-year mortality-associated factors were assessed. Results: Results indicate the proportion of those infected through intravenous drug use in older PWH has increased (4.7% in 1998–2003 vs. 24.7% in 2015–2021), as well as those born outside Spain (7.5% vs. 21.8%), alongside a lesser percentage of late HIV diagnoses (59.9% vs. 46.8%), reflecting a change in older PWH epidemiological profile. The presence of ≥3 comorbidities emerged as a significant predictor of 5-year mortality in the latest cohort, while CD4 + cell count of <200 cells/μl at the age of 60 lost significance [1998–2008: hazard ratio (HR): 3.19 (confidence interval, CI: 1.18–8.63) – 2015–2021: HR:1.38 (CI: 0.74–2.59)], underscoring the transition to the chronic disease era of the HIV pandemic. Conclusion: Despite advanced treatment strategies have improved HIV health indicators, new challenges have emerged among the older PWH. Tailored interventions addressing the unique difficulties faced by this population are essential to optimize HIV care outcomes.