Although the overall population of people with diagnosed HIV (PWDH) in the US is projected to age substantially between 2025 and 2040, these effects will unfold differently across states, with more populous and urban states experiencing even further aging while more rural and less populous states show little change.
The median age of adult people with diagnosed HIV (PWDH) in the US is projected to increase from 51 years in 2025 to 61 years by 2040.
By 2040, approximately 46% of adult PWDH in the US are projected to be older than 65 years.
Substantial heterogeneity in age distributions of PWDH was found across states.
A calibrated decision analytic model of HIV transmission was used to project epidemic trajectories from 2025 to 2040 across 24 US states.
Health care systems will need to plan to adapt to changing state-level demographic patterns among PWDH in the coming years.
This research used a mathematical model of the HIV epidemic to forecast how the age profile of people living with diagnosed HIV (PWDH) in the United States will change between 2025 and 2040. Covering 24 states that together account for 86% of all diagnosed HIV cases in the country, the study found that the typical (median) age of adults living with HIV is expected to rise dramatically — from about 51 years old in 2025 to about 61 years old by 2040. Even more striking, roughly 46% of all adults with diagnosed HIV are projected to be over 65 years old by 2040, compared to far smaller proportions today. The study also found that this aging trend will not happen equally everywhere. States that are more urban and more populous — and that already had older HIV-positive populations in 2025 — are projected to see the most dramatic aging over time. In contrast, states that are more rural and less populous tend to have younger HIV-positive populations, and those populations are not expected to age as rapidly in the coming 15 years. This geographic variation means that the healthcare challenges posed by an aging HIV population will look very different depending on where in the country one lives. This research suggests that healthcare systems, policymakers, and local planners will need to prepare for a very different HIV-positive population in the coming decades — one that is older and therefore more likely to have age-related health conditions such as heart disease, diabetes, and cognitive decline alongside their HIV care needs. Because these changes will vary significantly by state, local and regional planning will be essential, and national strategies alone may not adequately address the needs of specific communities.
Zalesak A, Kasaie P, Dansky Z, Althoff K, Dowdy D, Shah M, et al.. (2026). Projected Aging Among People With HIV in the US.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.32299