HIV Infected Elderly Women: From Rhetoric to Reality—Experience from Eastern India

Background: Detection of HIV among elderly is increasing globally and this is going to be a major public health issue in recent future. In India, data regarding demographical and clinical picture of HIV among elderly are sparse more so for elderly women. Elderly individuals especially women are still largely outside the light of HIV awareness programs and represent a major portion of undiagnosed HIV infected population with a poor quality of life. Methods and Materials: This cross-sectional study was conducted at HIV clinic of a tertiary care hospital in eastern India. 567 cases (men 457, women 110) that were detected to be HIV-positive at or after age of 50 years from 2008 to 2012 were analyzed on socio-demographical and clinical basis. Results: Detection of HIV was found to be increasing (5.7% in 2008 to 12.8% in 2012) among the elderly over last five years. Illiteracy (p < 0.01), unemployment (p < 0.001), seroconcordance of spouse (p = 0.02) and widowhood (p = 0.017) were seen more among elderly women. Frailty was the most common clinical presentation among elderly men (31%) whereas most of the elderly women were asymptomatic (27%) at the time of diagnosis. Mean CD4 count among HIV infected elderly men and women were 112 cells/dl and 137 cells/dl respectively at the time of diagnosis. Conclusions: HIV in elderly is an emerging entity in India and posing elderly women a worse socioeconomic burden despite a better clinical profile at the time of presentation. Clinicians, social workers and policymakers should come forward with wider awareness program targeted for elderly HIV patients especially women.

背景： 全球老年人群中艾滋病病毒（HIV）的检测呈上升趋势，这在不久的将来将成为一个重大的公共卫生问题。在印度，关于老年人群中HIV的人口统计学和临床情况的数据稀少，老年女性的相关数据更是如此。老年个体，尤其是女性，在很大程度上仍处于艾滋病防治宣传项目的覆盖范围之外，并且在未确诊的HIV感染人群中占很大比例，生活质量较差。 方法与材料： 这项横断面研究是在印度东部一家三级医疗医院的艾滋病诊所进行的。对2008年至2012年期间50岁及以上被检测出HIV阳性的567例病例（男性457例，女性110例）进行了社会人口统计学和临床方面的分析。 结果： 在过去五年中，老年人中HIV的检测率呈上升趋势（2008年为5.7%，2012年为12.8%）。老年女性中，文盲（p < 0.01）、失业（p < 0.001）、配偶血清学一致（p = 0.02）以及丧偶（p = 0.017）的情况更为常见。虚弱是老年男性最常见的临床表现（31%），而大多数老年女性在确诊时无症状（27%）。确诊时，感染HIV的老年男性和女性的平均CD4细胞计数分别为112个/微升和137个/微升。 结论： 在印度，老年人中的HIV是一个新出现的问题，尽管老年女性在就诊时临床状况较好，但却给她们带来了更沉重的社会经济负担。临床医生、社会工作者和政策制定者应针对老年HIV患者，尤其是女性，推出更广泛的宣传项目。