Parastu Kasaie1, Cameron Stewart2, Elizabeth Humes2, Lucas Gerace2, Jinbing Zhang2, Michael J Silverberg3, Michael A Horberg4, Peter F Rebeiro5, Emily P Hyle6, Viviane D Lima7, Cherise Wong8, M John Gill9, Kelly Gebo10, Richard Moore10, Mari M Kitahata11, Keri N Althoff2. 1. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: pkasaie@jhu.edu. 2. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 3. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. 4. Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA. 5. Department of Medicine, Divisions of Infectious Diseases & Epidemiology; Department of Biostatistics; Vanderbilt University School of Medicine, Nashville, TN, USA. 6. Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Harvard University Center for AIDS Research, Boston, MA, USA. 7. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 8. Global Patient Safety, Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA. 9. Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada. 10. Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA. 11. Department of Medicine, University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND: The age-distribution of men who have sex with men (MSM) continues to change in the 'Treat-All' era as effective test-and-treat programs target key-populations. However, the nature of these changes and potential racial heterogeneities remain uncertain. METHODS: The PEARL model is an agent-based simulation of MSM in HIV care in the US, calibrated to data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). RESULTS: PEARL projects a gradual decrease in median age of MSM at ART initiation from 36 to 31 years during 2010-2030, accompanied by changes in mortality among Black, White, and Hispanic MSM on ART by -8.4%, 42.4% and -19.6%. The median age of all MSM on ART is projected to increase from 45 to 47 years from 2010-2030, with the proportion of ART-users age ≥60y increasing from 6.7% to 28.0%. Almost half (49.7%) of White MSM ART-users are projected to age ≥60y by 2030, compared to 19.5% of Black and 17.2% of Hispanic MSM. CONCLUSIONS: The overall age of US MSM in HIV care is expected to increase over the next decade, and differentially by race/ethnicity. As this population age, HIV programs should expand care for age-related causes of morbidity and mortality.
BACKGROUND: The age-distribution of men who have sex with men (MSM) continues to change in the 'Treat-All' era as effective test-and-treat programs target key-populations. However, the nature of these changes and potential racial heterogeneities remain uncertain. METHODS: The PEARL model is an agent-based simulation of MSM in HIV care in the US, calibrated to data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). RESULTS: PEARL projects a gradual decrease in median age of MSM at ART initiation from 36 to 31 years during 2010-2030, accompanied by changes in mortality among Black, White, and Hispanic MSM on ART by -8.4%, 42.4% and -19.6%. The median age of all MSM on ART is projected to increase from 45 to 47 years from 2010-2030, with the proportion of ART-users age ≥60y increasing from 6.7% to 28.0%. Almost half (49.7%) of White MSM ART-users are projected to age ≥60y by 2030, compared to 19.5% of Black and 17.2% of Hispanic MSM. CONCLUSIONS: The overall age of US MSM in HIV care is expected to increase over the next decade, and differentially by race/ethnicity. As this population age, HIV programs should expand care for age-related causes of morbidity and mortality.
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