Projected Aging Among People With HIV in the US

Importance: As the population living with HIV in the US ages, state-level projections of the aging dynamics among people with diagnosed HIV (PWDH) will be needed to inform local planning and intervention efforts. Objective: To explore how aging dynamics of PWDH in the US are expected to differ at the state level between 2025 and 2040. Design, Setting, and Participants: This decision analytic model used a calibrated model of HIV transmission to project epidemic trajectories from 2025 to 2040 in 24 US states representing 86% of PWDH in the US. Main Outcomes and Measures: Change in median age of PWDH, among those older than 13 years, was estimated from 2025 to 2040 for each state. Results: Among the 24 states analyzed, projections showed that by 2040, the median age of adult PWDH will increase from a mean of 51 (95% credible interval [CrI], 51-52) years to 61 (95% CrI, 59-63) years, and 46% (95% CrI, 43%-48%) of adult PWDH will be older than 65 years. Substantial heterogeneities were found in age distributions by state. More populous and urban states with higher median ages of PWDH in 2025 were projected to experience even further aging of the population with diagnosed HIV in the coming 15 years. By contrast, more rural and less populous states had younger populations of PWDH that were not projected to age substantially over time. Conclusions and Relevance: This decision analytic model found that although the overall population of PWDH in the US is projected to age substantially, these effects will unfold differently across states. In the coming years, health care systems will need to plan to adapt to changing state-level demographic patterns among PWDH.