Systematic screening for age-related comorbidities: Health care optimization among persons with HIV in an outpatient...

Age-related comorbidities occur earlier and more frequently in people with HIV (PWH) than in the general population and have emerged as a key challenge in long-term HIV care. Unfortunately, many of these conditions remain undiagnosed, and systematic screening in clinical practice remains limited. Therefore, we aimed to assess the burden of unrecognized age-related comorbidities in a clinical outpatient setting.

This cross-sectional cohort study was conducted from November 2023 to March 2025 at the HIV outpatient clinic, Copenhagen University Hospital, Rigshospitalet. A structured screening procedure was implemented to assess unrecognized comorbidities among PWH aged ≥60 years. The screening comprised multiple guideline-recommended risk evaluations, including 10-year cardiovascular risk score (SCORE2), 10-year fracture risk assessment (FRAX), assessment of chronic lung disease and frailty.

A total of 387/532 (72.7%) eligible patients participated. Of patients without a history of cardiovascular disease, 203/300 (67.6%) were categorized as high risk and 57/300 (19%) as very-high risk by SCORE2. Primary preventive lipid-lowering therapy was prescribed in 75/203 (36.9%) and 18/57 (31.6%) in the high-risk and very-high risk groups, respectively. Of participants without prior chronic lung disease, 29/324 (9%) reported symptoms, and 20/260 (7.7%) with available spirometry had airflow limitation. Among PWH without a history of osteoporosis, 127/335 (37.9%) were categorized as high risk of major fracture and/or hip fracture. Pre-frailty or frailty was identified in 88/387 (22.7%) patients.

The considerable burden of unrecognized age-related comorbidities in PWH ≥60 years of age highlights the need for a systematic approach to early detection and preventative management.