Causes, risks and care circumstances associated with death in older adults diagnosed with HIV in a tertiary centre in Malaysia

Author:

Wong Hoi Yee1,Pui Li Wong1,Abdul Kahar Maria Kahar Bador1,Chong Meng Li2,Shenoi Sheela3ORCID,Rozanova Julia3,Syed Omar Sharifah Faridah1,Neelamegam Malinee4,Lee Yew Kong5,Rajasuriar Reena1ORCID

Affiliation:

1. Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

2. Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia

3. AIDS Program, Yale School of Medicine, New Haven, CT, USA

4. Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA

5. Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Abstract

Background A substantial number of older adults succumb soon after HIV diagnosis despite ART. We explored the causes, risk factors and circumstances before death among older adults acquring HIV. Methods We recruited individuals newly diagnosed at our centre from 2016-2020 and analysed data of those who died. Patients were stratified to older (≥50 years) or younger (<50 years) based on their age at diagnosis and attributes were compared. The Cox proportional multivariable model was used to identify factors associated with all-cause mortality. Results Among 75 deaths reported, the majority of deaths were AIDS-related and late presentation was common in both age groups. The majority of deaths occurred in the first 12 months after care presentation and over two-thirds in both groups disengaged from care prior to death. Older age remained an independent factor associated with death after adjusting for confounders including opportunistic infections, late presentation to care, ART initiation and chronic comorbidities at presentation. Conclusion Most causes of death in our setting were AIDS-related and associated with late care presentation both in young and older individuals, although older age at diagnosis remained an independent risk factor. Our findings highlight the urgent need to encourage prompt ART initiation following diagnosis, especially in older adults.

Publisher

SAGE Publications

Reference23 articles.

1. Journeys to HIV testing and diagnosis among adults aged 50+ years in England: A qualitative interview study

2. New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004–15: an analysis of surveillance data

3. Kirwan PDCC, Brown AE, Gill ON, Delpech VC and contributors. HIV in the UK - 2016 report, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/602942/HIV_in_the_UK_report.pdf (2016, Accessed 12 January 2022).

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