HIV and aging: time for a new paradigm.

Area of Science:

• Geriatrics
• Infectious Diseases
• Public Health

Background:

• The population of patients with HIV infection is growing, aging, and experiencing more non-AIDS related conditions.
• AIDS-defining illnesses are decreasing but still impact outcomes for aging individuals with HIV.
• HIV, its treatment, and associated factors continue to influence the health spectrum of aging patients.

Purpose of the Study:

• To advocate for a paradigm shift in HIV care from focusing solely on viral suppression and AIDS-defining illnesses.
• To emphasize the management of HIV as a complex chronic disease with multiple overlapping causes of morbidity and mortality.
• To highlight the need for strategies that maximize functional status, minimize frailty, and prolong life expectancy in aging HIV patients.

Main Methods:

• This study is a conceptual review and paradigm proposal, not based on empirical data collection.
• It synthesizes current understanding of HIV as a chronic condition in aging populations.
• It proposes the development of a composite index to assess morbidity and mortality risk.

Main Results:

• Current HIV management paradigms are insufficient for the aging, virally suppressed population.
• Morbidity and mortality in aging HIV patients stem from multiple, overlapping factors beyond traditional AIDS markers.
• A new approach is required to optimize long-term health and quality of life.

Conclusions:

• Optimal management of HIV infection requires a shift towards treating it as a complex chronic disease.
• A new care paradigm is necessary to address the multifaceted health challenges faced by aging individuals with HIV.
• Developing a composite index for morbidity and mortality risk could guide future care and research.