Projected Aging Among People with HIV in the United States: A Modeling Analysis in 24 States

ImportanceAs 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. ObjectiveWe sought to explore how aging dynamics of the population with HIV in the US are expected to differ at the state level between 2025 and 2040. Design, Setting, and ParticipantsWe projected epidemic trajectories from 2025 to 2040 in 24 US states comprising 86% of PWDH in the US using a calibrated model of HIV transmission. Main Outcomes and MeasuresWe estimated change in median age of PWDH over age 13, from 2025 to 2040, for each state. ResultsWe project that by 2040, the median age of adult PWDH in the 24 states will rise from 51 to 62 years, and over half of adult PWDH will be over the age of 65. Our projections suggest substantial heterogeneities in age distributions by state. More populous and urban states with higher median ages of PWDH in 2025 are 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 tend to have younger-aged HIV epidemics that were not projected to age substantially over time. Conclusions and RelevanceAlthough the overall population of persons with diagnosed HIV in the US is projected to age substantially, these effects will unfold differently across states. In the coming years, healthcare systems will need to plan to adapt to changing state-level demographic patterns among PWDH. Key PointsO_ST_ABSQuestionC_ST_ABSHow will the age distribution of people living with diagnosed HIV change between 2025 and 2040? FindingsUsing a calibrated model of HIV transmission in 24 US states, we project that by 2040, the median age of adult PWDH in the 24 states will rise from 51 to 62 years, and over half of adult PWDH will be over the age of 65. Our projections suggest substantial differences in age distribution by state. MeaningIn the coming years, federal and local healthcare planning will need to adapt to changing state-level demographic patterns among PWDH.