Ageing with HIV: Clinical and Organisational Challenges and the Role of Physical Activity in Healthy Ageing
DOI:
https://doi.org/10.12775/QS.2026.73.74914Keywords
HIV, ageing, healthy ageing, physical acitvity, exercise, multimorbidity, frailty, polypharmacy, hiv-associated neurocognitive disorder, models of care, comprehensive geriatric assessmentAbstract
Background. Combination antiretroviral therapy (ART) has transformed HIV into a manageable chronic condition. Consequently, the population of people living with HIV (PLWH) is ageing rapidly, with over 50% aged 50 or older in many high-income settings.
Objective. To characterise the clinical and organizational challenges at the intersection of HIV and biological ageing, highlight regular physical activity as a modifiable determinant of healthy ageing, and summarise emerging models of integrated HIV-geriatric care.
Methods. A narrative review of English-language literature (PubMed/MEDLINE) and current EACS and WHO guidelines was conducted. Search terms covered HIV, ageing, multimorbidity, frailty, polypharmacy, neurocognitive disorders, cardiovascular disease, physical activity, and care models. Landmark studies, systematic reviews, and meta-analyses were prioritised.
Results. Chronic inflammation ("inflammaging"), immunosenescence, ART toxicity, and traditional risk factors drive accelerated biological ageing in PLWH. This manifests as premature multimorbidity, increased cardiovascular, metabolic, and bone disease burden, HIV-associated neurocognitive disorder (HAND), non-AIDS cancers, and frailty. Polypharmacy complicates management, while traditional HIV services remain ill-equipped. Regular aerobic and resistance exercise represents a safe, cost-effective intervention that improves cardiorespiratory fitness, muscle strength, body composition, and physical function.
Conclusions. Caring for ageing PLWH requires a shift toward integrated, multidisciplinary, geriatric-informed models. Essential elements include screening for comorbidities and frailty, medication reviews, physical activity promotion, and adopting frameworks like WHO ICOPE, which should be urgently implemented in national care systems, including Poland’s.
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