Cardiometabolic multimorbidity in aging adults with HIV: Real-world evidence from a care cohort in Taiwan

BACKGROUND: As the population of people living with HIV (PLWH) ages, the burden of non-cardiometabolic diseases-including diabetes mellitus (DM), hypertension, and hyperlipidemia-has increased. However, data on age-specific cardiometabolic multimorbidity and real-world treatment gaps remain limited. METHODS: We conducted a retrospective study of 227 PLWH aged ≥50 years at a tertiary HIV center in Taiwan, stratified into premature-old (50-64 years) and old (≥65 years) groups. We assessed prevalence, incidence, and risk factors of cardiometabolic conditions, and applied Taiwan National Health Insurance(TNHI) criteria to evaluate statin eligibility. RESULTS: Among 227 PLWH, 182 were aged 50-64 (premature-old) and 45 were ≥65 (old). At follow-up, the prevalence of diabetes, hypertension, and hyperlipidemia reached 32.2 %, 48.5 %, and 76.2 %, respectively. Multimorbidity increased from 28.0 % to 46.7 % in premature-old group and 48.9 %-73.3 % in old group. Risk factors for DM included body mass index (BMI) ≥24.0 kg/m² and high-density lipoprotein cholesterol (HDL-C) <40 mg/dL. Risk factors for hypertension included HIV diagnosis >5 years, BMI ≥24.0 kg/m², HDL-C <40 mg/dL, chronic kidney disease (CKD), and specific antiretroviral regimens. BMI ≥24.0 kg/m², HDL-C <40 and CKD increased the risks for hyperlipidemia. Among statin non-users, 33.3 % of premature-old and 40.0 % of old patients met TNHI eligibility criteria. CONCLUSION: Cardiometabolic multimorbidity is common among aging PLWH in Taiwan. The premature-old group showed considerable disease burden and treatment gaps, indicating missed prevention opportunities. These findings emphasize the need for age-appropriate, integrated care approaches to address the evolving health challenges in this population.