Background: In many industrialized countries, the prevalence of HIV and AIDS among persons 50 years of age and older has increased in recent years. Improved antiretroviral efficacy has extended survival such that many individuals who contracted the disease earlier in the epidemic are now entering older age. Continued primary infection also contributes to the significant volume of prevalent infections in older individuals. Management of these older HIV-infected patients is complicated by the presence of co-morbidities that are more common with increasing age, such as diabetes mellitus, cancer, and cardiovascular, renal, hepatic, and bone diseases. Some of these conditions have been linked with HIV infection or with its treatment. However, even in these older HIV-infected patients, age is associated with an increased risk of co-morbidities.
Conclusions: The critical research question at this point is to tease out the relative contribution of age, HIV status, and antiretroviral exposure to these co-morbidities, and to determine whether there are reversible issues or management strategies that are specific to HIV-infected individuals. Until these research issues are resolved, the presence or risk of co-morbidities in older persons should become part of routine care. Management of older persons with HIV should include baseline evaluation of cardiovascular risk and regular monitoring of fasting lipid and glucose levels, renal function, and markers of bone disease. Furthermore, because avoidance of metabolic and other toxicities or drug–drug interactions is a key issue, co-morbidities have an important influence on antiretroviral selection.