Lancet Report Recommends Paradigm Shift in Care for Older Adults with HIV
A new report published in The Lancet HIV urges healthcare systems to expand care for older adults living with HIV beyond standard antiretroviral therapy (ART) and adopt a more comprehensive healthy-aging approach. The report was led by researchers from the Johns Hopkins Bloomberg School of Public Health and Yale School of Medicine, in collaboration with experts from more than 40 institutions and nine people living with HIV.
Although many new HIV infections occur among younger individuals, the global population living with HIV is steadily aging. Nearly one-third of people living with HIV were over the age of 50 in 2025, and this proportion is projected to increase to approximately half by 2040. The researchers emphasize the need for healthcare systems to address the distinct challenges associated with HIV prevention, screening, treatment, and long-term care among older adults.
The report recommends regularly assessing biological or physiological age and changes in physical function, reducing unnecessary or excessive medication use, supporting mental well-being, and encouraging healthy lifestyle practices. These measures should be integrated with continued adherence to ART to support healthier aging and improve long-term quality of life.
Published online in The Lancet HIV on July 27, the report was presented on July 28 at the AIDS 2026 conference in Rio de Janeiro, Brazil.
According to joint first author Keri Althoff, PhD, MPH, older adults living with HIV may experience a physiological age that is greater than their chronological age because of the long-term effects of chronic infection. She noted that the growing number of older people living with HIV presents an increasing challenge for healthcare systems worldwide and requires immediate attention.
The report’s other joint first author is Amy Justice, MD, PhD, the Peter N. Herbert Professor of Internal Medicine and Professor of Public Health at Yale School of Medicine.
The World Health Organization estimated that approximately 40 million people worldwide were living with HIV by late 2024. ART remains the foundation of HIV treatment, as it suppresses viral replication and prevents the progression of HIV to AIDS. Although ART must be taken continuously, advances in treatment have enabled many people living with HIV to achieve a near-normal life expectancy.
However, older adults living with HIV may experience additional health challenges. These include stigma that can affect access to care and HIV screening, as well as the long-term effects of earlier treatments and persistent immune activation. Together, these factors may contribute to accelerated aging and the earlier development of chronic, age-related health conditions.
As people living with HIV grow older, they often develop greater medical complexity and face an increased risk of multiple age-related conditions. The report stresses that effective care should not focus only on maintaining viral suppression but should also prioritize physical function, mental health, overall well-being, and quality of life.
The authors also recommend developing HIV prevention and screening programs specifically designed for older adults. These services should address ageism and stigma while considering the population’s unique health, social, and financial needs.
The report warns that many healthcare systems are not yet adequately prepared to manage the growing number of older adults living with HIV. Fragmented healthcare services, separate care pathways, complex appointment schedules, and out-of-pocket expenses may create barriers to comprehensive and coordinated care.
To address these challenges, the researchers recommend integrating existing HIV programs with broader chronic disease management and incorporating geriatric care into HIV services. They also highlight the importance of connecting individuals with HIV to community-based organizations and digital health tools. Strengthening collaboration among patients, healthcare providers, and communities could help create more coordinated, accessible, and effective systems that support healthy aging with HIV.
