Projecting changes in demographics and causes of death in people with HIV in western Europe from 2025 to 2050: a mathematical modelling study.
Using data from the Antiretroviral Therapy Cohort Collaboration (ART-CC), the Centre for Disease Prevention and Control (ECDC), and UNAIDS, Ambia J et al modelled cause-specific mortality from 2025 to 2050 in people living with HIV in Western Europe. They used epidemiological data from 2010–2023 from more than 136,000 people receiving antiretroviral therapy in ten European cohorts participating in ART-CC, including the Swiss HIV Cohort Study, to develop a mathematical model. The model projected demographic changes and mortality from 2025 to 2050 under several scenarios, varying future HIV incidence and coverage of antiretroviral therapy (ART).
The projections show a marked ageing of the population living with HIV. Under the status quo scenario, the proportion aged over 75 years is expected to triple, from 8% in 2025 to 24% in 2050, while median age increases from 53 to 60 years. As a consequence, despite continuing effective HIV treatment, overall mortality is projected to increase from 1.31 to 2.04 deaths per 100 person-years. The causes of death are also expected to shift further away from HIV-related conditions with non-AIDS-defining cancers and cardiovascular diseases becoming the leading causes of death by 2050. Importantly, the different scenarios demonstrate that further progress remains possible: increasing ART coverage while steadily reducing new HIV infections could prevent more than 15,000 deaths over the next 25 years.
These findings illustrate the consequences of the success of modern HIV treatment: people living with HIV live longer, and their healthcare needs change accordingly. Preventing new HIV infections, ensuring early diagnosis and maintaining high ART coverage remain key, but HIV care also needs to address healthy ageing. Prevention and management of cardiovascular disease, cancer and other age-related conditions has to become an important part of comprehensive long-term HIV care.