Journal of Education Health and Sport · Sep 24, 2026
Ageing with HIV Clinical and Organisational Challenges of Care
By Kilian TB, Kopcińska P, Kawa M et al.
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.