Characteristics of acquired immunodeficiency syndrome in older adults

OBJECTIVE: To examine demographic and clinical features of older AIDS patients in comparison with younger individuals. DESIGN: Data base review. SETTING: Maryland AIDS Registry from 1981 through the end of 1994. PARTICIPANTS: All registered Maryland AIDS cases greater than or equal to 60 years of age at diagnosis and all Maryland AIDS cases aged 20 to 39. MAIN OUTCOME MEASURES: Demographic features, mode of transmission and change in mode over time, clinical presentations, CD4+ counts, and survival time. RESULTS: A total of 321 (2.7%) AIDS cases diagnosed in Maryland were people 60 years of age or older compared with 7511 cases (63.9%) in people aged 20 to 39 years. The proportion of whites was higher in the older group, but the gender distribution was similar to younger counterparts. Transfusion was the primary cause of exposure of 32% of the older people with AIDS; however, during the last few years, sexual transmission and drug abuse have been implicated more frequently. Twelve percent of older patients had no reported risk factors compared with 4% of younger AIDS patients. The most common presenting AIDS indicator disease in older cases was Pneumocystis carinii pneumonia. Wasting syndrome, candidiasis, and HIV encephalopathy also occurred frequently. Median life span was 9 months compared with 22 months in the young. CONCLUSION: Our study demonstrates that transfusion is no longer the leading cause of AIDS in older people in Maryland. The relatively increased prominence of transmission by other modes in this age group raises the importance of preventive and educational measures. Older patients generally have a shorter survival than younger individuals.