Special Topics in the Care of Older People with HIV

  • Tessa del Carmen
  • Carrie Johnston
  • Chelsie Burchett
  • Eugenia L. SieglerEmail author
HIV Medicine (C Yoon, Section Editor)
Part of the following topical collections:
  1. Topical Collection on HIV Medicine


Purpose of review

Antiretroviral therapy has enabled many people with HIV to live long lives with their infection, but the literature suggests that long-term survivors are developing comorbidities and aging-related syndromes at earlier ages than their non-infected counterparts. In addition, there is evidence of sex-based differences in comorbidity risk.

Recent findings

How to best care for people aging with HIV is not known, but the tools of comprehensive geriatric assessment can identify people at risk for decline. Newer antiretroviral therapies offer promise of fewer side effects and drug interactions. We will also discuss special needs of women aging with HIV.


People with HIV and their providers are often unprepared to confront issues of aging, and each clinical program must develop methods to assess older patients and manage age-related complications and syndromes.


Aging Geriatric syndromes Women’s health Comprehensive geriatric assessment Stigma HIV 


Compliance with Ethical Standards

Conflict of Interest

Dr. Siegler has received salary support for an investigator-initiated study from Gilead Sciences, Inc.

Drs. Johnston and Del Carmen and Ms. Burchett declare that they have no conflicts of interest.

Dr. Johnston has grant support from NIH/NIAID T32 AI007613.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, van Sighem A, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis. 2015;15(7):810–8.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention. HIV Surveillance Report 2017 [Internet]. 2018 [cited 2019 Feb 13] p. 129. Report No.: Volume 29. Available from:
  3. 3.
    HIV Epidemiology and Field Services Program. 2017 HIV Surveillance Annual Report [Internet]. New York, NY: New York City Department of Health and Mental Hygiene; 2018. [cited 2019 Feb 13] p. 20. Available from: Scholar
  4. 4.
    De Francesco D, Wit FW, Bürkle A, Oehlke S, Kootstra NA, Winston A, et al. Do people living with HIV experience greater age advancement than their HIV-negative counterparts? AIDS. 2019;33(2):259.PubMedCrossRefGoogle Scholar
  5. 5.
    Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, et al. Cross-sectional Comparison of the Prevalence of Age-Associated Comorbidities and Their Risk Factors Between HIV-Infected and Uninfected Individuals: The AGEhIV Cohort Study. Clin Infect Dis. 2014;59(12):1787–97.PubMedCrossRefGoogle Scholar
  6. 6.
    Kong AM, Pozen A, Anastos K, Kelvin EA, Nash D. Non-HIV Comorbid Conditions and Polypharmacy Among People Living with HIV Age 65 or Older Compared with HIV-Negative Individuals Age 65 or Older in the United States: A Retrospective Claims-Based Analysis. AIDS Patient Care STDs. 2019;33(3):93–103.PubMedCrossRefGoogle Scholar
  7. 7.
    Guaraldi G, Malagoli A, Calcagno A, Mussi C, Celesia BM, Carli F, et al. The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 – 74 years and more than 75 years. BMC Geriatr. 2018;18(1):99.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Greene M, Justice AC, Covinsky KE. Assessment of geriatric syndromes and physical function in people living with HIV. Virulence. 2017;8(5):586–98.PubMedCrossRefGoogle Scholar
  9. 9.
    Greene M, Covinsky KEM, Valcour V, Miao YM, Madamba JB. Lampiris HM#, et al. Geriatric Syndromes in Older HIV-Infected Adults. J Acquir Immune Defic Syndr. 2015;69(2):161–7.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Do AN, Rosenberg ES, Sullivan PS, Beer L, Strine TW, Schulden JD, et al. Excess burden of depression among HIV-infected persons receiving medical care in the united states: data from the medical monitoring project and the behavioral risk factor surveillance system. PLoS One. 2014;9(3):e928423.Google Scholar
  11. 11.
    Kelly SG, Wu K, Tassiopoulos K, Erlandson KM, Koletar SL, Palella FJ. Frailty Is an Independent Risk Factor for Mortality, Cardiovascular Disease, Bone Disease, and Diabetes Among Aging Adults With Human Immunodeficiency Virus. Clin Infect Dis. 2019; 27;69(8):1370–1376. Available from: Accessed 29 Dec 2019CrossRefGoogle Scholar
  12. 12.
    The White House Office of National AIDS Policy. National HIV/AIDS Strategy for The United States: Updated to 2020. 2015;74. Accessed 11 May 2019
  13. 13.
    Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and Racial/Ethnic HIV Disparities: Moving Toward Resilience. Am Psychol. 2013;68(4):225–36.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Emlet CA. “You’re Awfully Old to Have This Disease”: Experiences of Stigma and Ageism in Adults 50 Years and Older Living With HIV/AIDS. The Gerontologist. 2006;46(6):781–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Shen MJ, Freeman R, Karpiak S, Brennan-Ing M, Seidel L, Siegler EL. The intersectionality of stigmas among key populations of older adults affected by HIV: a thematic analysis. Clin Gerontol. 2018;0(ja):1–13.Google Scholar
  16. 16.
    Palar K, Frongillo EA, Escobar J, Sheira LA, Wilson TE, Adedimeji A, et al. Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States. AIDS Behav. 2018;22(12):3869–78.PubMedCrossRefGoogle Scholar
  17. 17.
    Turan B, Smith W, Cohen MH, Wilson TE, Adimora AA, Merenstein D, et al. Mechanisms for the Negative Effects of Internalized HIV-Related Stigma on Antiretroviral Therapy Adherence in Women: The Mediating Roles of Social Isolation and Depression. J Acquir Immune Defic Syndr. 2016;72(2):198–205.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    • Stangl AL, Earnshaw VA, Logie CH, van Brakel W, C. Simbayi L, Barré I, et al. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17(1):31 Recognizing the importance of better addressing health related stigmas, the Health Stigma and Discrimination Framework was developed to enhance methods for research and policy.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Tinetti M, Huang A, Molnar F. The Geriatrics 5M’s: A New Way of Communicating What We Do. J Am Geriatr Soc. 2017;65(9):2115–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Singh HK, Del Carmen T, Freeman R, Glesby MJ, Siegler EL. From One Syndrome to Many: Incorporating Geriatric Consultation into HIV Care. Clin Infect Dis. 2017;65(3):501–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Greene ML, Tan JY, Weiser SD, Christopoulos K, Shiels M, O’Hollaren A, et al. Patient and provider perceptions of a comprehensive care program for HIV-positive adults over 50 years of age: The formation of the Golden Compass HIV and aging care program in San Francisco. PLoS One. 2018;13(12):e0208486.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Siegler EL. Care of People Aging with HIV: Northeast/Caribbean AETC Toolkit, V.4 [Internet]: Northeast Caribbean AIDS Education and Training Center Program; 2018. Available from:
  23. 23.
    NECA AETC Clinical Support Tools [Internet]. 2019 [cited 2019 Mar 3]. Available from:
  24. 24.
    Walston J, Buta B, Xue Q-L. Frailty Screening and Interventions: Considerations for Clinical Practice. Clin Geriatr Med. 2018;34(1):25–38.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Tate JP, Sterne JAC, Justice AC. Improved discrimination of mortality with Veterans Aging Cohort Study (vacs) Index 2.0 in Hiv-positive individuals. AIDS. 2019;33(5):903–12.PubMedCrossRefGoogle Scholar
  26. 26.
    •• Montoya JL, Jankowski CM, O’Brien KK, Webel AR, Oursler KK, Henry BL, et al. Evidence-informed practical recommendations for increasing physical activity among persons living with HIV. AIDS. 2019;33(6):931–9 This review reinforces the central role increasing physical activity plays in the health of people with HIV.PubMedCrossRefGoogle Scholar
  27. 27.
    Hakkers CS, Kraaijenhof JM, van Oers-Hazelzet EB, Visser-Meily AJMA, Hoepelman AIM, Arends JE, et al. HIV and Cognitive Impairment in Clinical Practice: The Evaluation of a Stepwise Screening Protocol in Relation to Clinical Outcomes and Management. AIDS Patient Care STDs. 2017;31(9):363–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Jiao JM, So E, Jebakumar J, George MC, Simpson DM, Robinson-Papp J. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization. Pain. 2016;157(4):931.PubMedCrossRefGoogle Scholar
  29. 29.
    Uebelacker LA, Weisberg RB, Herman DS, Bailey GL, Pinkston MM, Stein MD. Chronic pain in HIV-infected patients: relationship to depression, substance use, and mental health and pain treatment. Pain Med. 2015;16(10):1870–81.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Bruce RD, Merlin J, Lum PJ, Ahmed E, Alexander C, Corbett AH, et al. 2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With HIV. Clin Infect Dis. 2017;65(10):e1–37.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Slomka J, Prince-Paul M, Webel A, Daly BJ. Palliative care, hospice, and advance care planning: Views of people living with HIV and other chronic conditions. J Assoc Nurses AIDS Care. 2016;27(4):476–84.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Guaraldi G, Pintassilgo I, Milic J, Mussini C. Managing antiretroviral therapy in the elderly HIV patient. Expert Rev Clin Pharmacol. 2018;11(12):1171–81.PubMedCrossRefGoogle Scholar
  33. 33.
    McLachlan AJ, Pont LG. Drug metabolism in older people--a key consideration in achieving optimal outcomes with medicines. J Gerontol A Biol Sci Med Sci. 2012;67(2):175–80.PubMedCrossRefGoogle Scholar
  34. 34.
    Le Couteur DG, Fraser R, Hilmer S, Rivory LP, McLean AJ. The hepatic sinusoid in aging and cirrhosis: effects on hepatic substrate disposition and drug clearance. Clin Pharmacokinet. 2005;44(2):187–200.PubMedCrossRefGoogle Scholar
  35. 35.
    • Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents [Internet]. US Department of Health and Human Services; 2013. Available from: The DHHS Guidelines includes a section about HIV in Older Adults under the category of “HIV in Specific Populations”.
  36. 36.
    Food and Drug Administration. FDA Approves the First Once-a-Day Three-Drug Combination Tablet for Treatment of HIV-1 News [Internet]. AIDSinfo. [cited 2019 May 8]. Available from:
  37. 37.
    • Llibre JM, Hung C-C, Brinson C, Castelli F, Girard P-M, Kahl LP, et al. Efficacy, safety, and tolerability of dolutegravir-rilpivirine for the maintenance of virological suppression in adults with HIV-1: phase 3, randomised, non-inferiority SWORD-1 and SWORD-2 studies. Lancet. 2018;391(10123):839–849. This study demonstrates non-inferiority of a novel two drug regimen to maintain viral suppression in individuals with suppressed viremia on a stable ARV regimen.CrossRefGoogle Scholar
  38. 38.
    Cahn P, Madero JS, Arribas JR, Antinori A, Ortiz R, Clarke AE, et al. Dolutegravir plus lamivudine versus dolutegravir plus tenofovir disoproxil fumarate and emtricitabine in antiretroviral-naive adults with HIV-1 infection (GEMINI-1 and GEMINI-2): week 48 results from two multicentre, double-blind, randomised, non-inferiority, phase 3 trials. Lancet. 2019;393(10167):143–55.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Nozza S, Malagoli A, Maia L, Calcagno A, Focà E, De Socio G, et al. Antiretroviral therapy in geriatric HIV patients: the GEPPO cohort study. J Antimicrob Chemother. 2017;72(10):2879–86.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Study Evaluating the Efficacy, Safety, and Tolerability of Switching to Long-acting Cabotegravir Plus Long-acting Rilpivirine From Current Antiretroviral Regimen in Virologically Suppressed HIV-1-infected Adults - Full Text View - [Internet]. Clinical [cited 2019 Mar 13]. Available from:
  41. 41.
    Study to Evaluate the Efficacy, Safety, and Tolerability of Long-acting Intramuscular Cabotegravir and Rilpivirine for Maintenance of Virologic Suppression Following Switch From an Integrase Inhibitor in HIV-1 Infected Therapy Naive Participants - Full Text View - [Internet]. [cited 2019 May 8]. Available from:
  42. 42.
    Swindells S, Andrade-Villanueva J, Richmond G, Rizzardini G, Baumgarten A, Masia MDM, et al. Long-acting cabotegravir + rilpivirine as maintenance therapy: ATLAS week 48 results | CROI Conference [Internet]. [cited 2019 May 8]. Available from:
  43. 43.
    Orkin C, Arastéh K, Hernández-Mora MG, Pokrovsky V, Overton ET, Girard P-M, et al. Long-acting cabotegravir + rilpivirine for HIV maintenance: FLAIR week 48 results | CROI Conference [Internet]. [cited 2019 May 8]. Available from:
  44. 44.
    Scott I, Hilmer S, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing Inappropriate Polypharmacy: The Process of Deprescribing. JAMA Intern Med. 2015;175(5):827–34.PubMedCrossRefGoogle Scholar
  45. 45.
    Catalan J, Tuffrey V, Ridge D, Rosenfeld D. HALL (HIV and Later Life) Team. What influences quality of life in older people living with HIV? AIDS Res Ther. 2017;14:22.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Mrus JM, Williams PL, Tsevat J, Cohn SE, Wu AW. Gender differences in health-related quality of life in patients with HIV/AIDS. Qual Life Res. 2005;14(2):479–91.PubMedCrossRefGoogle Scholar
  47. 47.
    Blackstock OJ, Tate JP, Akgün KM, Crystal S, Duggal M, Edelman EJ, et al. Sex Disparities in Overall Burden of Disease Among HIV-Infected Individuals in the Veterans Affairs Healthcare System. J Gen Intern Med. 2013;28(Suppl 2):577–82.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Rubin LH, Radtke KK, Eum S, Tamraz B, Kumanan KN, Springer G, et al. Cognitive Burden of Common Non-antiretroviral Medications in HIV-Infected Women. JAIDS J Acquir Immune Defic Syndr. 2018;79(1):83.PubMedCrossRefGoogle Scholar
  49. 49.
    Monsuez J-J, Belin C, Bouchaud O. Microvascular Function in Aging Among Women Living with HIV. Curr HIV/AIDS Rep. 2016;13(6):392–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Weitzmann MN, Ofotokun I, Titanji K, Sharma A, Yin MT. Bone Loss Among Women Living with HIV. Curr HIV/AIDS Rep. 2016;13(6):367–73.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Schnall R, Jia H, Olender S, Gradilla M, Reame N. In people living with HIV (PLWH), menopause (natural or surgical) contributes to the greater symptom burden in women: results from an online US survey. Menopause. 2018;25(7):744–52.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Utian WH. The International Menopause Society menopause-related terminology definitions. Climacteric. 1999;2(4):284–6.PubMedCrossRefGoogle Scholar
  53. 53.
    Andany N, Kennedy VL, Aden M, Loutfy M. Perspectives on menopause and women with HIV [Internet]. International Journal of Women’s Health. 2016; 11;8:1-22 Available from: Accessed 9 May 2019
  54. 54.
    Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA, et al. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;58(1):1–10.PubMedCrossRefGoogle Scholar
  55. 55.
    Womack J, Brandt C, Justice A. Primary Care of Women Aging with HIV. J Midwif Women’s Health. 2015;60(2):146–57.CrossRefGoogle Scholar
  56. 56.
    Volpe M, Uglietti A, Castagna A, Mussini C, Marchetti G, Bellagamba R, et al. Cardiovascular disease in women with HIV-1 infection. Int J Cardiol. 2017;241:50–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Womack JA, Chang C-CH, So-Armah KA, Charles A, Baker Jason V, Brown Sheldon T, et al. HIV Infection and Cardiovascular Disease in Women. J Am Heart Assoc. 3(5):e001035.Google Scholar
  58. 58.
    Stone L, Looby SE, Zanni MV. Cardiovascular Disease Risk among Women Living with HIV in North America & Europe. Curr Opin HIV AIDS. 2017;12(6):585–93.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Bairey Merz CN, Shaw LJ, Reis SE, Bittner V, Kelsey SF, Olson M, et al. Insights From the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part II: Gender Differences in Presentation, Diagnosis, and Outcome With Regard to Gender-Based Pathophysiology of Atherosclerosis and Macrovascular and Microvascular Coronary Disease. J Am Coll Cardiol. 2006;47(3, Supplement):S21–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Rubin LH, Maki PM, Springer G, Benning L, Anastos K, Gustafson D, et al. Cognitive trajectories over 4 years among HIV-infected women with optimal viral suppression. Neurology. 2017;89(15):1594–603.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    •• Maki PM, Rubin LH, Springer G, Seaberg EC, Sacktor N, Miller EN, et al. Differences in Cognitive Function Between Women and Men With HIV. JAIDS J Acquir Immune Defic Syndr.. 2018;79(1):101 This provocative study provides evidence that women with HIV are more vulnerable to HIV related cognitive dysfunction than their male counterparts.PubMedCrossRefGoogle Scholar
  62. 62.
    Cysique LA, Brew BJ. Vascular cognitive impairment and HIV-associated neurocognitive disorder: a new paradigm. J Neurovirol [Internet]. 2019 [cited 2019 Jan 18]; Available from: PubMedCrossRefGoogle Scholar
  63. 63.
    Sacktor N. Changing clinical phenotypes of HIV-associated neurocognitive disorders. J Neurovirol. 2018;24(2):141–5.PubMedCrossRefGoogle Scholar
  64. 64.
    • Chow FC, Regan S, Zanni MV, Looby SE, Bushnell CD, Meigs JB, et al. Elevated ischemic stroke risk among women living with HIV infection. AIDS. 2018;32(1):59 This study identified where HIV modifies the impact of sex specific risk factors on stroke risk in women with HIV.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Chow FC, Makanjuola A, Wu K, Berzins B, Kim K-YA, Ogunniyi A, et al. Physical Activity Is Associated With Lower Odds of Cognitive Impairment in Women but Not Men Living With Human Immunodeficiency Virus Infection. J Infect Dis. 2019;219(2):264–74.PubMedCrossRefGoogle Scholar
  66. 66.
    Sharma A, Shi Q, Hoover DR, Tien PC, Plankey MW, Cohen MH, et al. Frailty predicts fractures among women with and at-risk for HIV. AIDS. 2019;33(3):455–63.PubMedCrossRefGoogle Scholar
  67. 67.
    Erlandson KM, Lake JE, Sim M, Falutz J, Prado CM, Domingues da Silva AR, et al. Bone Mineral Density Declines Twice as Quickly Among HIV-Infected Women Compared With Men. J Acquir Immune Defic Syndr. 2018;77(3):288–94.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Triant VA, Brown TT, Lee H, Grinspoon SK. Fracture prevalence among human immunodeficiency virus (HIV)-infected versus non-HIV-infected patients in a large U.S. healthcare system. J Clin Endocrinol Metab. 2008;93(9):3499–504.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    McComsey GA, Tebas P, Shane E, Yin MT, Overton ET, Huang JS, et al. Bone Disease in HIV Infection: A Practical Review and Recommendations for HIV Care Providers. Clin Infect Dis. 2010;51(8):937–46.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Kanis JA on behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary health-care level. Technical Report. [Internet]. UK: World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield; 2007. [cited 2019 May 11]. Available from: Google Scholar
  71. 71.
    Biver E, Calmy A, Aubry-Rozier B, Birkhäuser M, Bischoff-Ferrari HA, Ferrari S, et al. Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis. Osteoporos Int. 2019;39(5):1125–35.CrossRefGoogle Scholar
  72. 72.
    Cejtin HE. Care of the human immunodeficiency virus–infected menopausal woman. Am J Obstet Gynecol. 2012;207(2):87–93.PubMedCrossRefGoogle Scholar
  73. 73.
    Brown TT, Hoy J, Borderi M, Guaraldi G, Renjifo B, Vescini F, et al. Recommendations for Evaluation and Management of Bone Disease in HIV. Clin Infect Dis. 2015;60(8):1242–51.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Geriatrics and Palliative MedicineWeill Cornell MedicineNew YorkUSA
  2. 2.Division of Infectious DiseasesWeill Cornell Medicine/New York Presbyterian HospitalNew YorkUSA

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