Racial/ethnic disparities in HIV diagnoses among persons aged 50 years and older in 37 US States, 2005-2008.
ABSTRACT We examined racial/ethnic disparities in HIV diagnosis rates for persons aged 50 years and older.
We analyzed surveillance data from the Centers for Disease Control and Prevention regarding HIV diagnoses during 2005 through 2008 in 37 states. Average annual rates of diagnoses were calculated for persons aged 50 years and older and compared with rates for persons aged 13 to 49 years.
The average annual rate of diagnosis (per 100,000 persons) for older persons was 9.8. Rates among older Blacks (49.2) and Hispanics/Latinos (19.5) were 12.6 and 5.0 times, respectively, the rate among older Whites (3.9); rates among younger Blacks (102.5) and Hispanics/Latinos (39.0) were 7.7 and 2.9 times, respectively, the rate among younger Whites (13.3). Older persons were more likely than younger persons to receive a late HIV diagnosis (prevalence ratio=1.5, P<.001).
Racial/ethnic disparities in HIV diagnosis rates are greater among persons aged 50 years and older than among younger persons. The greater HIV diagnosis rates in Blacks and later diagnosis among older persons of all races/ethnicities indicate a need to increase their awareness of risk factors for HIV infection.
SourceAvailable from: PubMed Central[Show abstract] [Hide abstract]
ABSTRACT: Background: With the widespread use of combination antiretroviral therapy (cART), life expectancy of HIV-infected patients has significantly prolonged. An increasing number of HIV-infected patients are aging and concurrent use of medications are not uncommon for management of metabolic complications and cardiovascular diseases related to aging and prolonged exposure to cART. Methods: We reviewed medical records of all HIV-infected patients aged 40 years or older who had been followed at a university hospital for HIV care in Taiwan between January and December 2013. A standardized case record form was used to collect information on demographics and clinical characteristics, comorbidity, cART, and concurrent medications. Results: During the study period, 610 patients aged 40 to 49 years (mean, 44.1) and 310 aged 50 years or older (mean, 58.8) sought HIV care at this hospital. Compared with patients aged 40 to 49 years, those aged 50 years or older were significantly more likely to be female (15.9% vs 3.8%); to have received cART (97.7% vs 94.8%) and a lower plasma HIV RNA load (1.6 vs 1.7 log(10) copies/ml); and to have diabetes mellitus (18.4% vs 4.6%), hypertension (31.0% vs 10.8%), hyperlipidemia (29.4% vs 11.6%), coronary artery disease (6.8% vs 0.5%), and an estimated glomerular filtration rate <60 ml/min/1.73 m(2) (11.5% vs 2.7%); and were significantly less likely to have syphilis. Other than HIV infection, patients aged 50 years or older were more likely to have been receiving two or more concurrent medications than those aged 40 to 49 years (22.9% vs 6.4%). Conclusions: Our findings show a significant proportion of the HIV-infected patients aged 50 years or older have multiple comorbidities that may increase the risk for cardiovascular and renal complications. Issues of poly-pharmacy among the HIV-infected patients who are aging should be addressed to ensure adherence and minimize drug-drug interactions.PLoS ONE 08/2014; 9(8):e104945. DOI:10.1371/journal.pone.0104945 · 3.53 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Objectives. We examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (≥ 50 years) people living with HIV/AIDS (PLWHA). Methods. We conducted frequency and descriptive statistics analysis to characterize our sample, which we drew from 2005-2007 Medicaid claims data from 14 states. We employed univariate and multivariable Cox regression analyses to evaluate the relationship between race, comorbidity, and timely ART initiation (≤ 90 days post-HIV/AIDS diagnosis). Results. Approximately half of the participants did not commence ART promptly. After we adjusted for covariates, we found that older PLWHA who reported a comorbidity were 40% (95% confidence interval = 0.26, 0.61) as likely to commence ART promptly. We found no racial differences in the timely initiation of ART among older PLWHA. Conclusions. Comorbidities affect timely ART initiation in older PLWHA. Older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to older PLWHA. Consistent Medicaid coverage helps ensure consistent access to HIV treatment and care and may eliminate racial disparities in timely ART initiation among older PLWHA. (Am J Public Health. Published online ahead of print September 11, 2014: e1-e7. doi:10.2105/AJPH.2014.302227).American Journal of Public Health 09/2014; 104(11):e1-e7. DOI:10.2105/AJPH.2014.302227 · 4.23 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Abstract Limited data are available regarding adults age ≥50 at initial HIV diagnosis. Improved understanding of this group is critical in designing interventions to facilitate earlier diagnosis and linkage to HIV care. We characterize individuals newly diagnosed with HIV, particularly those ≥50 years old, and examine the relationship between age and late diagnosis defined as concurrent HIV and AIDS diagnoses. This is a retrospective study of individuals newly diagnosed with HIV from 2006-2011 at an academic medical center in New York City. Multivariable logistic regression was performed to evaluate the effect of age, gender, race/ethnicity, risk factor, and prior medical visits on late diagnosis. Adults age ≥50 comprised 21.3% of all newly diagnosed individuals. Among these older adults, 70.0% were diagnosed as inpatients and 68.9% concurrent with AIDS, compared to 41.7% and 38.9% of younger adults, respectively. On adjusted analyses, age ≥50 (OR 3.13, 95% CI 1.63, 5.98) and injection drug use (OR 4.4, 95% CI 1.31, 14.75) were positively associated with late diagnosis, whereas female gender was negatively associated with late diagnosis (OR 0.52, 95% CI 0.28, 0.98). Our data suggest that HIV testing efforts targeting older adults are essential to address the unmet needs of this population, including implementation of HIV screening guidelines in primary care settings.AIDS PATIENT CARE and STDs 09/2014; 28(10). DOI:10.1089/apc.2014.0152 · 3.58 Impact Factor