Projected Increases in Older People With HIV in the United States Through 2040.

Background: People with diagnosed HIV (PWDH) live longer but have increased co-morbidities than peers without HIV and premature ageing. In 2021, 54% of United States PWDH were aged ≥50 years. PWDH age distribution projections beyond 2030 are needed to plan future HIV and ageing 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%. Conclusions: 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 ageing-related care needs of PWDH are met.