Just over one in six people diagnosed with HIV in Europe between 2004 and 2015 was over 50 years of age, and new diagnoses in older people increased in 16 European countries across the same period, a study published today in The Lancet HIV shows.

The study found that older people (people aged 50 or older) were more likely than younger people (aged 15 to 49 years) to be diagnosed with advanced HIV disease, and acquire HIV through heterosexual sexual contact. Older people diagnosed with HIV were less likely to be migrants.

Looking at HIV surveillance data from 31 countries, researchers from the European Centre for Disease Prevention and Control and the EU/EEA HIV Surveillance Network, found that 54,102 people over 50 years of age were diagnosed with HIV between 2004 and 2015. The average rate per 100,000 people increased by 2.1% per year (p < 0.0009).

Glossary stigma Social attitudes that suggest that having a particular illness or being in a particular situation is something to be ashamed of. Stigma can be questioned and challenged. self-testing In HIV testing, when the person testing collects their own sample and performs the whole test themselves, including reading and interpreting the result.

Although the rate of new diagnoses in older people is less than a quarter of the rate in people aged under 50, between 2004 and 2015, the rate of diagnosis in older people increased in 16 countries.

Among the countries reporting an increase were Belgium (3.9% annual average increase – increasing from 2.61 new cases per 100,000 older people in 2004, to 4.15 in 2015), Germany (8.1%, from 0.72 new cases per 100,000 to 1.83), Ireland (5.4%, from 1.41 new cases per 100,000 to 3.33), and the UK (3.6%, increasing from 3.1 new cases per 100,000 to 4.32). By 2015, rates were highest in Estonia, Latvia, Malta, and Portugal (7.50, 7.17, 7.15 and 6.0 new cases per 100,000 older people, respectively).

At the time of HIV diagnosis, 39% of people over 50 had a CD4 cell count below 350 cells/mm3, indicating late diagnosis. Of these, almost three-quarters were diagnosed with a CD4 cell count below 200 cells/ mm3, indicating advanced HIV disease and a high risk of illness or death. In comparison, 26% of people under the age of 50 were diagnosed with a CD4 count below 350 cells/mm3, of whom just over half had a CD4 cell count below 200 cells/mm3.

The study authors warn that health care workers need to consider the possibility of HIV infection in older people. HIV testing guided by the presence of indicator conditions (those indicating immunodeficiency) should be implemented more widely, they suggest, along with opt-out testing in primary care and emergency care. Health care providers should also acknowledge that older people are sexually active but less likely to use condoms.

Older people may not have accurate information about HIV transmission or the risk of exposure, and may not consider themselves to be at risk.

“We need to make both healthcare workers and the general population aware of this issue to reduce stigma and inform people about HIV risks and prevention methods,” said study author Dr Lara Tavoschi, of the European Centre for Disease Prevention and Control, Sweden.

“Testing in healthcare settings and innovative HIV test approaches – such as self-testing – need to be more easily accessible to older people to improve early diagnosis and fast-track treatment initiation. When achieved, this should help to prevent further transmission and lower the risk of severe health complications, which is of utmost importance among older adults living with HIV as their risk of mortality is higher as compared to younger individuals.”