Aging and Mortality among People with Diagnosed HIV in Italy: Recent Trends and Projections

The advent of antiretroviral therapy (ART) has led to substantial increases in life expectancy among persons with diagnosed HIV (PWDH), and in turn, an increasingly older population. This represents a public health challenge, as older PWDH are more susceptible to age-related health morbidities compared to the general population. In this study, we triangulate diverse data sources to reconstruct the Italian PWDH age structure over the past decade to better-understand recent trends, and provide demographic projections through 2035. We find that the PWDH population grew from approximately 112,000 persons in 2012, to 140,000 in 2024, and forecasted to reach 155,000 by 2035. This is primarily driven by decreased PWDH mortality, with such decreases forecast to continue. Persons over 60, estimated as 8.6% of the PWDH population in 2012, had increased to over 20% by 2020, and are projected to reach 47.2% by 2035. By 2030, over 10% of PWDH in Italy are projected to be over 75, compared to less than 1% in 2012. Our results demonstrate that the Italian HIV care infrastructure must prepare for a dramatic shift from managing a predominantly young-adult disease to caring for a majority-elderly population within the next decade, representing an unprecedented transformation in the nature and scope of required services.