BY ALEX OLSON, M-4, BOSTON UNIVERSITY AND SANJEEV RAMPAM, M-4, BOSTON UNIVERSITY, STUDENT MEMBERS, COMMITTEE ON GERIATRIC MEDICINE
The ART Breakthrough
Antiretroviral therapy (ART) remains a major breakthrough in HIV care. Since its introduction, life expectancy for people living with HIV has risen sharply — the gap with the general population dropped from 44 years in 1996 to under 10 by 2011.
Today, those on stable ART can expect to live into their mid-to-late 70s, with estimates ranging from 75 to 80 years.
FatCamera/Getty Images.
As people with HIV live longer, the population is aging. Nationally, the number of individuals over 50 living with HIV highlights both ART’s success and the growing need for long-term care planning. In Massachusetts,
this trend is even more evident: over 60 percent of people with HIV are now over 50.
Despite longer lifespans, earlier and more frequent age-related comorbidities — like cardiovascular disease, neurocognitive decline, and frailty — pose unique challenges, resembling those seen in geriatric care.
Unique Needs for People Living with HIV
As people with HIV live longer, they are often navigating unique medical and social challenges:
- Multiple Comorbidities: More than 80 percent of adults over age 50 with HIV have at least one non-HIV–related comorbidity — such as cognitive decline, bone fragility, or certain cancers. These comorbidities also appear up
to a decade earlier than in the general population. Many patients may also face multiple psychiatric stressors that further impact their health and well-being.
- Risks of Polypharmacy: Polypharmacy, generally defined as the use of five or more prescribed medications, is associated with increased risks of pill burden, adverse drug interactions, falls, and hospitalizations. A recent
review found that among US adults living with HIV over the age of 50, the prevalence of polypharmacy is estimated at approximately 44 percent, with global rates ranging from 17 to 71 percent. Notably, many of these medications — such as
sleep aids, antidiabetic drugs, and opioids — are often inappropriately prescribed, posing significant risks to patient safety.
- Care Management: Care for older adults with HIV frequently involves multiple specialists, including infectious disease, cardiology, psychiatry, and endocrinology. Although this approach can enable comprehensive treatment,
fragmented care may result in conflicting advice, polypharmacy, and diminished patient-centered care.
- Social Drivers of Health: Aging with HIV is influenced not only by medical factors but also by stigma and social isolation. Older adults with HIV often encounter stigma in settings unfamiliar with the condition and its modern
management, which can further limit engagement in care and adherence to ART. These challenges may be especially relevant in long-term care facilities where older adults with HIV remain a minority.
Confronting Challenges
With a growing population of individuals aging with HIV, there is increased focus on addressing their complex health care needs. Identifying care gaps and connecting patients to appropriate resources is a key priority. The Health Resources and Services Administration (HRSA) has designated this a national initiative, funding efforts across the United States to reduce disparities. Massachusetts, in particular, reports a disproportionately high number of older adults living with HIV. At Boston Medical Center,
HRSA funding supported the development of the HIV-Endurance (HIVE) Clinic — a multidisciplinary model integrating infectious disease, geriatrics, pharmacy, nursing, and case
management. The clinic delivers individualized, systematic care for medically and socially vulnerable patients, offering a scalable framework for managing the intersection of HIV and aging.
Opportunities for Massachusetts and Health Care Providers
While advocates in Massachusetts are already working to ensure older individuals with HIV are included in policy conversations, sustainable funding is critical to move from discussion to action. Innovative care models like the HIVE Clinic demonstrate
the effectiveness of integrated, interdisciplinary approaches in improving health outcomes and quality of life. Expanding these types of programs statewide would help address the growing demand for aging-related HIV services. Proactive investment
in supportive services such as medical, mental health, and social care is essential in the mission to diminish health disparities across our state and be among the leaders in the nation.
Education for Providers
All health care providers must be aware of the resources available to support patients living with HIV, particularly those with early or atypical signs of age-related conditions such as cognitive decline, cardiovascular disease, or frailty. Numerous
online resources, including HIV.gov and NIH.gov,
offer valuable insights into the complex aging experience of people living with HIV. Additionally, local experts, such as the multidisciplinary team at the HIVE Clinic, are working to address both the known and emerging needs of this population.
Their efforts serve as a vital community resource and a model for how we can better support aging individuals with HIV through informed, compassionate, and individualized care.
