In the next 10-15 years the number of people aged 60 years and over will increase considerably. In 2010, 30% of patients in most large clinics of industrialised countries were >50 years of age, compared with over 50% today. Projections for the next 10-15 years suggest that 75% of patients will be over 50, and 40% will be over 60 years.
Older people living with HIV (OPLH) are more likely to experience late diagnosis, and have greater immunosuppression and impaired immune recovery. Consequences are multimorbidities, which increasingly include geriatric syndromes and underdiagnosed mental health disorders.
Geriatric syndromes in OPLH can appear 5-10 years earlier, and non-AIDS comorbidities occur at a younger age. Frailty is associated with an increased risk of cognitive decline and the prevalence of frailty is higher at all ages compared with controls, which is not usually observed in the general population until some 10-15 years later. Mobility, falls, depression, and cognitive impairment are all problematic for OPLH. Research suggests an accelerated ageing phenotype in OPLH may exist where increased DNA methylation indicates an increased biological age of about 5 years.
Multimorbidity leads to polypharmacy often including drugs with a high anticholinergic burden, which themselves may predispose to cognitive decline. However, ageing successfully with HIV is possible through early diagnosis, encouraging activities which contribute to cognitive reserve, and assessing comorbidity risks.