• Vol. 41 No. 12, 581–586
  • 15 December 2012

Presentation and Outcome Amongst Older Singaporeans Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS): Does Age Alone Drive Excess Mortality?

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ABSTRACT

Introduction: There is little detailed information on human immunodeficiency virus (HIV) amongst older adults in Singapore.

Materials and Methods: A retrospective study of 121 consecutive referrals of patients presenting for HIV care was conducted. Demographic, clinical and laboratory variables were collected. A prognostic model derived from the North American Veterans’ Affairs Cohort Study (VACS) was used to estimate prognosis.

Results: The median age at presentation was 43 (range, 18 to 76). Thirty-eight patients (31%) were aged 50 or older and 106 patients (88%) were male. Older patients were more likely to be of Chinese ethnicity (P = 0.035), married (P = 0.0001), unemployed or retired (P = 0.0001), and to have acquired their infection heterosexually (P = 0.0002). The majority of patients in both groups were symptomatic at presentation. Eighty-one (67%) had CD4 counts less than 200 at baseline with no observable differences in HIV ribonucleic acid (RNA) or clinical stage based on age. Non-Acquired Immunodeficiency Syndrome (AIDS) morbidity was observed more frequently amongst older patients. The estimated prognosis of patients differed significantly based on age. Using the VACS Index and comparing younger patients with those aged 50 and above, mean 5 year mortality estimates were 25% and 50% respectively (P <0.001). A trend towards earlier antiretroviral therapy was noted amongst older patients (P = 0.067) driven mainly by fewer financial difficulties reported as barriers to treatment.

Conclusion: Older patients form a high proportion of newly diagnosed HIV/AIDS cases and present with more non-AIDS morbidity. This confers a poor prognosis despite comparable findings with younger patients in terms of clinical stage, AIDS-defining illness, CD4 count and HIV viral load.


Singapore is a country of high income with a low level human immunodeficiency virus (HIV) epidemic, the yearly incidence of disease currently standing at 121.7 new infections per million population per year. Certain features of Singapore’s HIV epidemic are notable. Firstly, despite active screening programmes amongst high-risk populations and adult hospital in-patients, more than half of newly notified patients have advanced HIV infection at diagnosis (defined as an Acquired Immunodeficiency Syndrome (AIDS)-defining illness or CD4 count <200) and an even higher proportion are diagnosed in the course of medical assessment. Secondly, the ratio of male to female infections has been 9:1 or higher since the beginning of the epidemic, which now stands in stark contrast to the region of southeast Asia where 35% of infections are amongst women. Thirdly, the proportion of older patients amongst people living with HIV and AIDS (PLWHA) in Singapore is very high. Twenty-eight percent of patients diagnosed between 2005 and 2011 were 50 and above and 36% of this group were 60 or older.

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