Medscape | Aging with HIV: Is care keeping up with changing needs?

Medscape news story

Highly effective antiretroviral combination therapy (ART) has transformed HIV infection from a condition associated with a substantially shortened life expectancy into a manageable chronic disease. Simultaneously, the demographics of HIV infections have changed. Fewer individuals are acquiring HIV as awareness has increased, and effective prevention with HIV preexposure prophylaxis has become available. Meanwhile, individuals with HIV receiving ART are living to older ages despite age-related and HIV-associated comorbidities.

These advances in treatment are changing the need for targeted medical care in this population. This shift is already evident. Individuals with HIV aged 50 years or older are commonly described as “aging with HIV.” Highly developed countries account for 20%-50% of individuals with HIV, and estimates suggest that this proportion will exceed 70% by 2030.

The clinical management of HIV becomes more complex with advancing age. HIV increases the risk for age-related comorbidities, primarily because of chronic systemic inflammation associated with the infection, sometimes referred to as “inflammaging.” Common comorbidities include cardiovascular disease, chronic kidney disease, cancer, metabolic disorders, and mental and cognitive disorders. Simultaneously, advances in HIV treatment have opened new possibilities for individuals with HIV, including the prospect of a functional cure.

How do individuals with HIV perceive the specific challenges of aging with chronic illness? What are their needs and concerns, and how can treating physicians best support them? Few studies have examined how individuals with HIV perceive their own aging and health, including their “mental models” of the process. Such knowledge can help inform shared decision-making.

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