Differences in people living with HIV (PLWH) population aged over 50 years old receiving antiretroviral therapy (ART)

Abstract

To explore differences among the elderly people (aged over 50 years old) living with HIV (PLWH) who are receiving antiretroviral therapy (ART), we collected and analyzed data using cross-sectional research methods. Among 520 elderly PLWH on ART, those over 60 years old, compared to those aged 50–60, had lower levels of education, more retirees in occupation distribution, a lower rate of active consultation, a higher proportion of heterosexual transmission, and more complications. Additionally, this study demonstrated a greater incidence of severe disease symptoms and a higher rate of ART failure. These findings underscore the importance of prioritizing targeted nursing care and interventions for elderly PLWH in future healthcare strategies.

Background

In recent years, the optimization and standardized use of antiretroviral therapy (ART) has significantly extended the survival of people living with HIV (PLWH), with their life expectancy increasingly approaching that of the general population without additional complications [1]. Globally, PLWH are progressively aging [2], with the 50–59 age group being most prevalent and the 60–69 age group experiencing the fastest rise in disease incidence [3]. This underscores the urgent need for focused prevention and care for elderly PLWH [2].

Unlike the general population, PLWH has a unique age definition, earlier studies defined older PLWH as individuals aged 50 and above, differentiating them from sexually active populations aged 15–49 [4, 5]. The growing number of elderly PLWH [6] may partly result from this group being frequently overlooked [7], personal or health factors, and poor virus suppression in the body [8]. Predictive models estimate that by 2030, the proportion of PLWH aged over 50 years old will rise from 28% in 2010 to 73% [9]. This highlights the need for intensified efforts to achieve the 90-90-90 goals of the AIDS program, with a particular emphasis on treatment and care services tailored to the elderly [10].

In China, specific policies regarding antiretroviral therapy, such as the “four exemptions and one care” policy [11], have significantly improved HIV treatment outcomes. This policy has been very successful, covering 97% of China’s PLWH population 15 years ago [12], and is the key to PLWH entering the group of people over 50 years old. Additionally, the establishment of more HIV clinics and healthcare system reforms has further contributed to extending the life expectancy of PLWH [13]. In conclusion, the number of PLWH in the elderly has increased. Still, ART in different age groups over 50 is related to immune function, and the failure of ART affects the survival rate of patients, reminding us that this group deserves attention [8, 13]. The purpose of this study was to analyze the characteristics of elderly PLWH receiving ART, especially to compare 50–60 years old and over 60 years old, to find a nursing breakthrough for this group.

Methods

Research object

The data for this study were obtained from the China Comprehensive AIDS Prevention and Control Data Information Management System, a national, network-based platform for standardized AIDS management, ensuring high data quality and security [14]. The study included patients with PLWH at baseline aged over 50 enrolled in the system from 2007 to 2023 who were still receiving antiretroviral therapy and were regularly followed up. Cases with incomplete information, missing follow-up data, or those complicated by severe diseases or tumors were excluded. This rigorous information screening process is essential for analyzing differences in ART access among PLWH aged 50 years and older.

Statistical method

Statistical analysis was performed using SPSS Version 26.0 (IBM, Armonk, NY, USA) Count data were described by component ratio (%), comparison was performed by χ² test, and measurement data inconsistent with normal distribution were described by Median(P25, P75). Test level α = 0.05, P < 0.05 was considered statistically significant.

Results

A total of 520 elderly PLWH patients receiving ART were divided into two groups according to the research objectives: a 50–60 age group and a 60 years and older group. There were 267 PLWH cases in the 50–60 age group and 253 cases in the over-60 group, with the median ages being 55 (52, 58) years and 66 (63, 69) years, respectively. Among these patients, 81.9% were male, about one-third were divorced or widowed, 57.9% had low levels of education, and nearly 30% were retirees.

A total of 39.0% of the patients were diagnosed through taking the initiative to find, with all cases being sexually transmitted, and heterosexual transmission being the most common (58.8%). At the initial CD4 test, 46.3% of patients had a CD4 count of less than 200 cells/ul, 44.6% had severe disease symptoms, and 12.7% had comorbidities. At their first visit, 43.7% of patients did not receive ART promptly upon diagnosis. Among all patients, 65.8% received first-line ART regimens, and the failure rate of antiviral treatment was 10.8%. Compared with the PLWH group aged 50–60, the PLWH group aged 60 and above had a lower level of education (35.6% vs. 48.3%, p = 0.003), more retirees in occupation (54.2% vs. 6.4%, p<0.001), a lower proportion of proactive medical visits (34.4% vs. 43.4%, p = 0.034), a higher proportion of heterosexual transmission (64.8% vs. 53.2%, p = 0.007), more complications (15.8% vs. 9.7%, p = 0.038), higher proportion of severe disease symptoms (51.0% vs. 38.6%, p = 0.004), and higher rates of ART treatment failure (14.6% vs. 7.1%, p = 0.006), as shown in Table 1.

The failure rate of elderly PLWH ART is 10.8%, and PLWH failures among people over 60 years old account for 66.1% of the elderly population. Moreover, there were more retirees aged 60 and above in the PLWH group (59.5% vs. 21.0%, p = 0.013) with a higher proportion of severe disease symptoms (67.6% vs. 26.3%, p = 0.003) and more comorbidities (29.7% vs. 5.3%, p = 0.043), as shown in Table 2.

Table 1 Comparison of characteristics among elderly PLWH between the 50–60 years old group and the 60 years old and above group [n (%)]

Table 2 Comparative analysis of antiretroviral failure in individuals aged 50 and above [n (%)]

Discussion

Our study uniquely focuses on 520 elderly PLWH patients receiving antiretroviral therapy, examining the differences within this population. While extending the lifespan of PLWH is a positive outcome, elderly PLWH faces significant challenges [15]. This study found that among elderly PLWH receiving ART, individuals aged 60 and older had lower levels of education compared to those aged 50–60, with a higher proportion being retirees. Lower educational attainment may impact cognitive behavior and limit awareness of HIV/AIDS prevention [16]. Additionally, the older generation often lacked access to systematic sex education in their youth. Upon retirement, some may explore new experiences out of curiosity, increasing their risk of HIV infection, particularly through heterosexual transmission [3, 17]. Our findings further indicate that heterosexual transmission is more prevalent among PLWH over 60 years old. Driven by sexual activity, many elderly individuals are reluctant to adopt protective measures, heightening their risk of infection. Therefore, strengthening sexual health education for the elderly and promoting awareness of proper preventive measures are critically important.

We also found that PLWH aged 60 and older exhibit low awareness of proactively seeking medical attention, which can result in delayed diagnosis and adversely impact their health outcomes [18]. Furthermore, elderly patients who delay seeking medical care are often in poorer health and face a higher risk of developing severe disease symptoms. This increases the likelihood of coexisting with non-HIV-related diseases, a conclusion supported by the model analysis conducted by Kong AM et al. [19]. So, initiating antiretroviral therapy as early as possible, while the body still retains robust immune function, can significantly improve treatment success rates for elderly PLWH and reduce disease-related mortality.

According to previous studies, the likelihood of virological failure in elderly PLWH patients is 18% higher compared to younger individuals [20]. Our latest research results indicate that the failure rate of ART treatment for elderly PLWH is 10.8%, with the most common being among PLWH aged 60 and older. Several factors may explain this: elderly individuals often exhibit poor immune function and heightened sensitivity to drug side effects [21]. This is primarily due to the presence of multiple chronic diseases common in this age group and the impact of aging on overall prognosis [22]. Moreover, the concurrent use of multiple medications during treatment can lead to a significant medication burden [23], which negatively affects ART adherence. In addition, elderly PLWH often experiences feelings of shame or face societal discrimination, further compromising treatment adherence [24]. These factors collectively contribute to higher rates of treatment noncompliance and ART failure in this population. To enhance treatment adherence among elderly PLWH, it is essential to address not only physical and mental health but also emotional well-being, while increasing access to psychological support [25]. Furthermore, attention should be given to adapting nursing models for elderly PLWH and combating stigma and discrimination from both patients and society. In summary, we emphasize the need for tailored, precise care for elderly PLWH, particularly those aged 60 and older, to improve treatment outcomes and overall quality of life.

Conclusion

Our study found significant population differences between PLWH aged 50–60 years and those over 60 years who are receiving ART. With variations in the importance and challenges of nursing care across different age groups. Understanding how to implement early and effective interventions will be crucial, in shaping the direction of future research and discussion. The health system must pay special attention to these age-specific needs to improve outcomes for elderly PLWH.