Ageing with HIV: Epidemiological Transition, Biological Mechanisms, and the Impact of Evolving Antiretroviral Therapy

The scale up of antiretroviral therapy (ART) has led to the evolution of HIV infection into a chronic condition, leading to a rapid growth in the number of older adults with HIV. This trend involves several biological, medical, and psychological challenges that go beyond conventional HIV treatment. The current mini-review provides a summary of recent data (2014 – 2026) regarding the changing epidemiology of HIV, biological aspects of ageing, and comorbidities and health systems associated with ageing. Ageing is driven by persistent immune activation, inflammation, immune senescence, and microbial translocation, all of which accelerate biological ageing. These biological factors lead to more comorbid conditions, such as cardiovascular disease, metabolic conditions, neurocognitive diseases, osteoporosis, and tumours, occurring more often and being worse than in the average population. Psychological issues, like stigma, social isolation, and mental problems, continue to be major concerns for people living with HIV (PLWH), having a significant impact on their lives. Management in the clinical setting has become even more complex due to the presence of multimorbidity and polypharmacy, requiring integrative and patient-focused strategies to manage both HIV and other age-associated illnesses. As far as public health is concerned, there are new challenges associated with ageing with HIV.