In this retrospective study, we report 43 cases (41 males and 2 females) of human immunodeficiency virus (HIV) infection in the Singapore population aged 50 years and above at first presentation. We found an increasing proportion of these older individuals among our HIV-seropositive patients, from 4.8% in 1991 to 16.7% by mid-1996. The mean age at presentation was 59.2 years (range, 50 to 75 years). They were mainly heterosexuals (93%), and the majority (79.1%) were previously or currently married. Thirty-six (83.7%) patients had multiple sexual exposures to commercial sex workers. Nearly all had acquired the infection through the sexual route.
The majority (76.7%) were symptomatic at presentation. Common clinical presentations were weight loss (72%), respiratory symptoms (60%) and oral candidiasis (56%). More than half (58.1%) of the patients had acquired immunodeficiency syndrome (AIDS) at the time of first presentation, with a median CD4 count of 17 cells/mm³. Pneumocystis carinii pneumonia and tuberculosis were the common AIDS-defining illnesses. Survival in patients presenting with AIDS (median survival, 3 months) was poorer compared with younger HIV-seropositive patients (<50 years; median survival, 1 year). No increase in age-related infections or malignancies was seen. Common causes of death were pneumonia and septicaemia.
Physicians should consider HIV infection in older patients, particularly when they present with unexplained weight loss, respiratory symptoms and oral candidiasis. A history of high-risk sexual behaviour should be sought in all patients, including the elderly.
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The author(s) declare there are no affiliations with or involvement in any organisation or entity with any financial interest in the subject matter or materials discussed in this manuscript.
