Long-term evolution of the burden of HIV/AIDS in older adults: a global burden of disease analysis in individuals aged ≥75 years in G7 countries.

Background: With the widespread implementation of antiretroviral therapy (ART), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has gradually transitioned from a highly fatal infectious disease to a manageable chronic condition. Simultaneously, global population aging has accelerated, making older adults with HIV (≥75 years) an increasingly important group in terms of disease burden. However, the epidemiological characteristics, disease spectrum, and long-term trends of this population-including key metrics such as incidence, mortality, prevalence, and disability-adjusted life years (DALYs)-remain inadequately assessed, particularly regarding epidemiological transitions and inter-country differences in this age group across G7 nations. Methods: Data on HIV/AIDS and its subtypes from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) 2021 database for G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) among individuals aged ≥75 years. Metrics included age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and DALYs. Stratified analyses were performed by age groups (75-79, 80-84, 85-89, 90-94, ≥95 years), sex, and disease subtype. Long-term trends were assessed using Joinpoint regression, calculating the annual percent change (APC) and average annual percent change (AAPC). Results: Between 1990 and 2021, the incidence and mortality of HIV/AIDS in older adults declined continuously in most G7 countries, reflecting the effectiveness of ART and public health interventions. In contrast, prevalence and DALYs increased in some countries, indicating an asymmetric pattern of "decreasing incidence and mortality, but increasing survival and disability." Considerable heterogeneity existed among countries: the United States and several European countries exhibited a high burden among surviving individuals, whereas Japan showed a consistently increasing trend. Sex-specific analysis revealed a higher overall burden in males than females, although the sex gap narrowed in the oldest age groups. The disease spectrum shifted over time, with a declining burden of drug-susceptible tuberculosis and non-communicable chronic diseases (conditions associated with HIV/AIDS) emerging as the primary drivers of DALYs. Conclusion: Older adults should be incorporated into HIV prevention, screening, and health management strategies, with particular attention to chronic disease management, functional maintenance, and multidisciplinary care to address the long-term health challenges posed by aging HIV cohorts.