Antiretroviral Therapy in Older Adults with HIV

The advent of combination antiretroviral therapy (ART) has transformed HIV infection from a rapidly fatal illness into a manageable chronic condition, leading to a growing cohort of people aged 50 years and older living with HIV. This demographic shift poses unique clinical and public health challenges, including accelerated biological ageing, increased burden of non‐communicable comorbidities such as cardiovascular disease, diabetes and osteoporosis, and altered pharmacokinetics in the context of polypharmacy. Immunosenescence, the age‐related deterioration of the immune system, may blunt CD4+ T‐cell recovery despite effective viral suppression, while persistent inflammation contributes to end‐organ disease. Ageing adults often present later in the course of infection with lower baseline CD4+ counts and higher viral loads, underscoring the importance of timely diagnosis and early ART initiation. Optimal management requires integrated, multidisciplinary care that addresses drug–drug interactions, adherence support and screening for age‐related conditions. Globally, resource‐limited settings face additional hurdles in monitoring virological response and delivering comprehensive geriatric care, making tailored services and task‐shifting essential to maximise the gains of ART in older populations.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Antiretroviral Therapy in Older Adults with HIV publication trend

The graph below shows the total number of articles in antiretroviral therapy in older adults with hiv across all publications each year (not limited to Nature Index journals).

Technical terms

Antiretroviral therapy (ART): Combination of drugs that inhibit HIV replication to suppress viral load.

Comorbidity: Co‐occurrence of one or more additional health conditions alongside HIV infection.

Immunosenescence: Age-related decline in immune function leading to reduced pathogen defence and vaccine response.

Polypharmacy: Concurrent use of multiple medications, raising the risk of drug–drug interactions.

Viral suppression: Reduction of HIV RNA in the bloodstream below detectable levels.

CD4+ T‐cell: Subset of lymphocytes targeted by HIV; key indicator of immune system health.

References

1. Treatment‐naïve people living with HIV aged 50 years or older in Beijing, China, 2010–2020: joinpoint regression model analysis of surveillance data. Journal of the International AIDS Society (2023).
2. HIV Infection in the Elderly: Arising Challenges. Journal of Aging Research (2016).
3. Survival of people aged 50 years and older by HIV and HIV treatment status: findings from three waves of the SAGE-Wellbeing of Older People Study (SAGE-WOPS) in Uganda. AIDS Research and Therapy (2020).