Demographics of HIV and aging

Abstract

Purpose of review: To describe and understand why the HIV-infected population is aging in high-income countries, the rate and causes of death in comparison with the general population, and to illustrate the impact of combined antiretroviral therapy (cART) on life expectancy and to discuss needs for further researches.

Recent findings: The HIV-infected population is aging in high-income countries because of increasing age at HIV infection, higher risk of late diagnosis in older individuals and decrease in the AIDS-defining and non-AIDS-defining death rates. Compared with the general population, the risk of death is no longer elevated in many non-IDU-infected individuals successfully treated with cART.

Summary: Further researches are needed to reconcile the absence of increased mortality risk in HIV-infected individuals with controlled viral load and restored immunity with the observed higher risk of comorbidities, such as cardiovascular diseases and non-AIDS-defining cancers, and the accelerated aging hypothesis, in particular, to help stratify HIV individuals who are at risk; to define the optimal management of multimorbidity and polypharmacy, even in the absence of a higher comorbidity risk; and to better account for increased life expectancy and multimorbidity burden to plan the future needs in care for HIV-infected individuals.