Ageing with HIV Clinical and Organisational Challenges of Care
DOI:
https://doi.org/10.12775/JEHS.2026.95.74100Keywords
Key words: HIV; ageing; multimorbidity; frailty; polypharmacy; HIV-associated neurocognitive disorder; models of care; comprehensive geriatric assessment.Abstract
Combination antiretroviral therapy (ART) has transformed human immunodeficiency virus (HIV) infection from a fatal disease into a manageable chronic condition; consequently, the population of people living with HIV (PLWH) is ageing rapidly. In many high-income settings more than half of PLWH are now aged 50 years or older. To characterise the clinical and organisational challenges that arise when HIV infection and biological ageing intersect, and to summarise the emerging models of integrated HIV-geriatric care intended to address them. A narrative review of English-language literature indexed in PubMed/MEDLINE was conducted, complemented by the current guidelines of the European AIDS Clinical Society (EACS) and the World Health Organization (WHO). Search terms combined the concepts of HIV, ageing, multimorbidity, frailty, polypharmacy, neurocognitive disorders, cardiovascular disease and models of care. Landmark studies, systematic reviews, meta-analyses and large cohort studies were prioritised. Chronic immune activation and inflammation ("inflammaging"), immunosenescence, and the cumulative effects of ART and traditional risk factors drive accelerated and accentuated biological ageing in PLWH. This manifests as premature multimorbidity, an increased burden of cardiovascular disease, metabolic and bone disorders, HIV-associated neurocognitive disorder (HAND), non-AIDS-defining cancers, frailty, and geriatric syndromes. Polypharmacy and drug-drug interactions further complicate management, and traditional HIV services are poorly configured for these needs. Caring for the ageing HIV population requires a paradigm shift towards integrated, multidisciplinary and geriatric-informed models of care, systematic screening for comorbidity and frailty, structured medication review, and adoption of frameworks such as the WHO Integrated Care for Older People (ICOPE) approach. These changes should be urgently implemented in national HIV care systems, including Poland’s.
References
References
Choinka, M., Konopka, A., Wdowiak, N., Szczepaniak, Z., Kalisiak, J., Szpernalowska, A., Matshaba, V. I., Mrugała, K. The Human Immunodeficiency Virus - a Review of the clinical aspects and detection of the infection. Quality in Sport, 2024:23:55368:55368. https://doi.org/10.12775/QS.2024.23.55368
Mahy, M., Autenrieth, C. S., Stanecki, K., Wynd, S. Increasing trends in HIV prevalence among people aged 50 years and older: Evidence from estimates and survey data. AIDS. 2014:28:453-459, https://doi.org/10.1097/QAD.0000000000000479
Bhatta, M., Nandi, S., Dutta, N., Dutta, S., Saha, M. K. HIV care among elderly population: Systematic review and meta-analysis. AIDS Research and Human Retroviruses, 2020:36(6), 475-489. https://doi.org/10.1089/AID.2019.0098
Sprague, C., Brown, S. M. Local and global HIV aging demographics and research. Interdisciplinary Topics in Gerontology and Geriatrics, 2016:42,1-10. https://doi.org/10.1159/000448532
Kearney, F., Moore, A. R., Donegan, C. F., Lambert, J. The ageing of HIV: Implications for geriatric medicine. Age and Ageing, 2010:39(5), 536-541. https://doi.org/10.1093/ageing/afq083
Duffau, P., Ozanne, A., Bonnet, F., Lazaro, E., Cazanave, C., Blanco, P., Riviere, E., Desclaux, A., Heyernard C., Gensous N., Pellegrin, I.,. L., Wittkop L. Multimorbidity, age-related comorbidities and mortality: Association of activation, senescence and inflammation markers in HIV adults. AIDS, 2018:32(12), 1651–1660. https://doi.org/10.1097/QAD.0000000000001875
Brañas, F., Azcoaga, A., García Ontiveros, M., & Antela, A. Chronicity, ageing and multimorbidity. Enfermedades Infecciosas y Microbiología Clínica (English ed.), 2018:36(1), 15–18. https://doi.org/10.1016/S0213-005X(18)30241-6
Warriner A.H., Burkholder G., Overton E.T., HIV-related metabolic comorbidities in the current ART era. Infectious Disease Clinics of North America, 2014:28(3), 457–476. https://doi.org/10.1016/j.idc.2014.05.003
Rodés, B., Cadiñanos, J., Esteban-Cantos, A., Rodríguez-Centeno, J., & Arribas, J. R. Ageing with HIV: Challenges and biomarkers. EBioMedicine, 2022:77:103896. https://doi.org/10.1016/j.ebiom.2022.103896
Paternò Raddusa, M. S., Marino, A., Celesia, B. M., Spampinato, S., Giarratana, C., Venanzi Rullo, E., Cacopardo, B., Nunnari, G. Atherosclerosis and cardiovascular complications in people living with HIV: A focused review. Infectious Disease Reports, 2024:16(5), 846–863. https://doi.org/10.3390/idr16050066
Cournoyer J.M., Bowers M.T., Relf M.V., Cardiovascular disease and HIV: Pathophysiology, treatment considerations, and nursing implications. Critical Care Nurse, 2016:36(5),1–9. https://doi.org/10.4037/ccn2016839
Aurpibul, L., Srithanaviboonchai K., Musumari P.M., Prevalence of subclinical atherosclerosis and risk of atherosclerotic cardiovascular disease in older adults living with HIV. AIDS Research and Human Retroviruses, 2019:35(11–12),1136–1142. https://doi.org/10.1089/AID.2019.0023
Pereira, B., Mazzitelli M., Milinkovic A., Moyle G., Mandalia S., Al-hussaini A., Boffito M., Predictive value of HIV-related versus traditional risk factors for coronary atherosclerosis in people aging with HIV. AIDS Research and Human Retroviruses, 2021:38(2),80–86. https://doi.org/10.1089/AID.2021.0064
Nathan W. Cummins Metabolic complications of chronic HIV infection: A narrative review. Pathogens, 2022:11(2),197. https://doi.org/10.3390/pathogens11020197
Morse, C. G., & Kovacs, J. A., Metabolic and skeletal complications of HIV infection: The price of success. JAMA, 2006:296(7),844–854. https://doi.org/10.1001/jama.296.7.844
Zetola N., Pilcher C., Diagnosis and management of acute HIV infection Infectious Disease Clinics of North America, 2007:21:1:19-48 https://doi.org/10.1016/j.idc.2007.01.008
Rosenthal, J., & Tyor, W., Aging, comorbidities, and the importance of finding biomarkers for HIV-associated neurocognitive disorders. Journal of NeuroVirology, 2019:25(5), 673–685. https://doi.org/10.1007/s13365-019-00735-0
Mackiewicz M., Overk C., Achim C.L., Masliah E., Pathogenesis of age-related HIV neurodegeneration. Journal of NeuroVirology, 2019: 25(5), 619–633. https://doi.org/10.1007/s13365-019-00728-z
Kompella S., Al-Khateeb T., Riaz O.A., Orimaye S.O., Sodeke P.O., Awujoola A.O., Ikekwere J., Goodkin K., HIV-associated neurocognitive disorder (HAND): Relative risk factors. Current Topics in Behavioral Neurosciences, 2020:50,63–79. https://doi.org/10.1007/7854_2020_131
Milanini, B., Samboju, V., Cobigo, Y., Paul, R., Javandel, S., Hellmuth, J., Allen, I., Miller, B., Valcour, V., Longitudinal brain atrophy patterns and neuropsychological performance in older adults with HIV-associated neurocognitive disorder compared with early Alzheimer’s disease. Neurobiology of Aging, 2019:82, 69–76. https://doi.org/10.1016/j.neurobiolaging.2019.07.006
Shiels, M. S., Engels, E. A., Evolving epidemiology of HIV-associated malignancies. Current Opinion in HIV and AIDS, 2017:12(1), 6–11. https://doi.org/10.1097/COH.0000000000000327
Chiao, E. Y., Coghill, A., Kizub, D., Fink, V., Ndlovu, N., Mazul, A., Sigel, K., The effect of non-AIDS-defining cancers on people living with HIV. The Lancet Oncology, 2021:22(6), e240–e253. https://doi.org/10.1016/S1470-2045(21)00137-6
Cattelan A.M., Mazzitelli M., Presa N., Cozzolino C., Sasset L., Leoni D., Bragato B., Scaglione V., Baldo V., Parisi S.G., Changing prevalence of AIDS and non-AIDS-defining cancers in an incident cohort of people living with HIV over 28 years. Cancers, 2023:16(1),70. https://doi.org/10.3390/cancers16010070
Wang, C. C. J., Silverberg M.J., Abrams D.I., Non-AIDS-defining malignancies in the HIV-infected population. Current Infectious Disease Reports, 2014:16(6),406. https://doi.org/10.1007/s11908-014-0406-0
Marin, S., Quinnes C., Codina-Jimenez C., Valls E., Terricabras E., Estrada L., Cardona G., Andreu A., The management of polypharmacy in people living with HIV. AIDS Reviews, 2023:25(1), 27–40. https://doi.org/10.24875/AIDSRev.M23000059
Linfield, R. Y., Nguyen N.N., Laprade O.H., Holodniy M., Chary A., An update on drug–drug interactions in older adults living with human immunodeficiency virus (HIV). Expert Review of Clinical Pharmacology, 2024:17(7),589–614. https://doi.org/10.1080/17512433.2024.2350968
Holtzman, C., Armon, C., Tedaldi, E., Chmiel, J. S., Buchacz, K., Wood, K., Brooks, J. T., the HIV Outpatient Study (HOPS) Investigators., Polypharmacy and risk of antiretroviral drug interactions among the aging HIV-infected population. Journal of General Internal Medicine, 2013:28(10),1302-1310. https://doi.org/10.1007/s11606-013-2449-6
Bastida C., Grau A., Marquez M., Tuset M., De Lazzari E., Martinez E., Gatell J.M., Polypharmacy and potential drug–drug interactions in an HIV-infected elderly population. Farmacia Hospitalaria, 2017:41(5), 618–624. https://doi.org/10.7399/fh.10778
Cattaneo, D., Oreni L., Meraviglia P., Minisci D., Astuti N., Antinori S., Gori A., Gervasoni, C., Polypharmacy and aging in people living with HIV: 6 years of experience in a multidisciplinary outpatient clinic. Drugs & Aging, 2023:40(7), 665–674. https://doi.org/10.1007/s40266-023-01037-1
Brothers, T. D., Kirkland, S., Guaraldi, G., Falutz, J., Theou, O., Johnston, B. L., & Rockwood, K. Frailty in people aging with human immunodeficiency virus (HIV) infection. The Journal of Infectious Diseases, 2014:210(8),1170–1179. https://doi.org/10.1093/infdis/jiu258
Yamada Y., Kobayashi T., Condo A., Sangarlangkarn A., Ko F., Taniguchi Y., Kojima G., Prevalence of frailty and prefrailty in people with human immunodeficiency virus aged 50 or older: A systematic review and meta-analysis. Open Forum Infectious Diseases, 2022:9(5),129. https://doi.org/10.1093/ofid/ofac129
Levett T. J., Cresswell F. V., Malik M. A., Fisher M., Wright J., Systematic review of prevalence and predictors of frailty in individuals with human immunodeficiency virus. Journal of the American Geriatrics Society, 2016:64(5),1006–1014. https://doi.org/10.1111/jgs.14101
Branas F., Jimenez Z., Sanchez-Conde M., Dronda F., Lopez-Bernaldo De Quiros J.C., Perez-Elias M., Miralles P., Ramirez M., Moreno A., Berenguer J., Frailty and physical function in older HIV-infected adults. Age and Ageing, 2017:46(3), 522–526. https://doi.org/10.1093/ageing/afx013
Brañas F., Torralba M., Antela A., Vergas J., Ramírez M., Ryan P., Dronda F., Galindo M. J., Machusa I., Bustinduy M.J., Cabello A., Montes M.L., Sanchez-Conde M., Effects of frailty, geriatric syndromes, and comorbidity on mortality and quality of life in older adults with HIV. BMC Geriatrics, 2023:23(1), 4. https://doi.org/10.1186/s12877-022-03719-8
Zamudio-Rodríguez A., Belaunzarán-Zamudio P. F., Avila-Funes J.A. Crabtree-Ramírez B. E., Alcalá-Zermeno J. L., Sierra-Madero J.G., Amieva H., Avila-Funes J.A., Association between frailty and HIV-associated neurodegenerative disorders among older adults living with HIV. AIDS Research and Human Retroviruses, 2018:34(5),449–455. https://doi.org/10.1089/AID.2017.0100
Zhabokritsky A., Klein M., Harris M., Loutfy M., Guillemi S., Tan D.H, Falutz J., Nisha A., Giovanni G., Locblom L.E., Walmsley S., Prevalence and correlates of frailty among older adults living with HIV in the CHANGE HIV cohort. Journal of Acquired Immune Deficiency Syndromes, 2024:97(3), 226–231. https://doi.org/10.1097/QAI.0000000000003485
Dunville R., Greene M. Innovative models of care supporting people aging with HIV. Current Opinion in HIV and AIDS, 2025:20(4), 367–372. https://doi.org/10.1097/COH.0000000000000939
Kokorelias K. M., Grosse A., Zhabokritsky A., Sirisegaram L., Understanding geriatric models of care for older adults living with HIV: A scoping review and qualitative analysis. BMC Geriatrics, 2023:23(1), 417. https://doi.org/10.1186/s12877-023-04114-7
Davis A.J., Greene M., Siegler E., Fitch K. V., Schmalzle S.A., Krain A., Vera J.H., Boffito M., Falutz J., Erlandson K.M., Strengths and challenges of various models of geriatric consultation for older adults living with human immunodeficiency virus. Clinical Infectious Diseases, 2022:74(6), 1101–1106. https://doi.org/10.1093/cid/ciab682
Tan J. Y., Greene M., Blat C., Albers A., Grochowski J., Oskarsson J., Shiels M., Olson B., Guzman D., Hessol N. A. Examining the impact of the Golden Compass clinical care program for older people with HIV: A qualitative study. AIDS and Behavior, 2022:26(5), 1562–1571. https://doi.org/10.1007/s10461-021-03509-0
Guaraldi G., Marcotullio S., Maserati R., Gargiulo M., Milic J., Franconi I., Chirianni A., Andreoni M., Galli M., Lazzarin A., D’Arminio A., Di Perri G., Perno C.-F., Puoti M., The management of geriatric and frail HIV patients: A 2017 update from the Italian guidelines for the use of antiretroviral agents and the diagnostic clinical management of HIV-1 infected persons. The Journal of Frailty & Aging, 2019:8(1), 10–16. https://doi.org/10.14283/jfa.2018.42
Bertagnoli L., Iannuzzi P., Ciccone S., Canevelli M., Marzetti E., Guaraldi G., Cesari M., Older HIV-infected adults: Complex patients – geriatric syndromes (II). European Geriatric Medicine, 2019:10(2), 213–218. https://doi.org/10.1007/s41999-019-00160-w
Guaraldi G., Palella F. J. Jr., Clinical implications of aging with HIV infection: Perspectives and the future medical care agenda. AIDS, 2017:31:129–135. https://doi.org/10.1097/QAD.0000000000001478
Guaraldi G., Milic J., Gozzi L., Ambrosio S., Delmonte E., Avazini I., Castelnuovo B., Mussini C., Introducing the WHO ICOPE approach into HIV care: A perspective on healthy ageing in people living with HIV. JAR Life, 2026:15,100047. https://doi.org/10.1016/j.jarlif.2025.100047
Ambrosioni, J., Levi L.I., Alagaratnam J., Sempere A., Mastrangelo A., Paioni P., Mussini C., Marzolini C., Nielsen S.D., Beguelin C., Welch S., Major revision version 13.0 of the European AIDS Clinical Society guidelines 2025. HIV Medicine, 2025:27(1),18–32. https://doi.org/10.1111/hiv.70120
World Health Organization. (2021). Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: Recommendations for a public health approach. World Health Organization. https://www.who.int/publications/i/item/9789240031593
Greene, M., Justice, A. C., Lampiris, H. W., et al. Management of human immunodeficiency virus infection in advanced age. JAMA, 2013:309(13),1397–1405. https://doi.org/10.1001/jama.2013.2963
Greene, M., Covinsky, K. E., Valcour, V., Miao, Y., Madamba, J., Lampiris, H., Cenzer, I. S., Martin, J., Deeks, S. G. Geriatric syndromes in older HIV-infected adults. Journal of Acquired Immune Deficiency Syndromes, 2015:69(2),161–167. https://doi.org/10.1097/QAI.0000000000000556
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Tomasz Kilian, Paulina Kopcińska, Michał Kawa, Kamil Idzik, Dominika Grzybowska, Agnieszka Anna Gaczoł, Weronika Grzyb-Kurnik, Michał Kurnik, Gabriela Piotrowska, Aleksander Urbaś, Magdalena Mortka, Hubert Bednarz
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 16
Number of citations: 0
