• Vol. 41 No. 12, 577–580
  • 15 December 2012

Older Age at Initial Presentation to Human Immunodeficiency Virus (HIV) Care and Treatment at the Communicable Disease Centre (CDC) in Singapore, 2006 to 2011

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ABSTRACT

Introduction: The incidence of newly diagnosed older patients diagnosed with human immunodeficiency virus (HIV) has increased worldwide in recent years. In this study, we compared the demographics and clinical presentation of younger and older patients in our HIV sentinel cohort.

Materials and Methods: Among all HIV patients presenting to the Communicable Disease Centre (CDC), Singapore from 2006 to 2011, 793 were randomly included in our cohort, representing about 50% of the patients seen during that period. We collected demographic, clinical, laboratory, and outcome data from patient records to compare younger (<50 years old) and older (≥50 years old) HIV patients.

Results: Older patients comprised 27.1% of our HIV cohort and presented with lower median CD4 T cell counts (65 cells/mm3 , interquartile range [IQR]: 27 to 214 cells/mm3 ) compared to younger patients (250 cells/mm3 , IQR: 74 to 400 cells/mm3 ; P <0.001). The median time from HIV diagnosis to initiation of antiretroviral therapy (ART) differed significantly for both age groups as well (49 days for patients <50 years old, IQR: 18 to 294 days; versus 35 days for patients ≥50 years old, IQR: 14 to 102 days; P = 0.008). More of our younger patients were single (72.2%) or homosexual (44.1%), in contrast to older patients, of whom 48.8% were married and 84.7% were heterosexual.

Conclusion: Upon comparison of our younger and older patients, we identified distinct differences in risk transmission and clinical presentation. Increased awareness of older patients at risk of HIV may improve time to diagnosis among this age group.


Since the first case of human immunodeficiency virus (HIV) in Singapore was identified in 1985, the incidence of HIV/acquired immunodeficiency syndrome (AIDS) has steadily increased, reaching a peak rate of 125.2 cases per million population in 2008. From 2006 to 2011, 28.3% of newly diagnosed HIV/AIDS cases in Singapore were aged 50 years and above, an increase from 20.7% during 1985 to 2005. A 1997 study from the Communicable Disease Centre (CDC), Singapore observed an increasing proportion of older HIV patients from 4.8% in 1991 to 16.7% in mid-1996. Altoff et al noted a similar trend in their large North American cohort, in which 17% of newly diagnosed HIV positive cases were aged 50 years and above in 1997 and 27% in 2007.

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