Thanks to the development and widespread use of highly active antiretroviral therapy (ART) since the mid-1990s, the life expectancy of people living with the human immunodeficiency virus (HIV) has greatly increased. As a result, there is a growing population of older adults living with HIV.

According to the U.S. Centers for Disease Control and Prevention (CDC), 59 percent of people living with HIV in the U.S. were 45 years or older in 2019. Around 24 percent were aged 45 to 54, and around 34 percent were 55 and older.

Life Expectancy With HIV

Advancements in HIV treatment have significantly narrowed the life expectancy gap between people living with HIV and the general population, especially among those who start treatment early and who are able to maintain high CD4 counts (levels of CD4 T cells). A 2023 study spanning from 1996 to 2019 showed that, for people with higher CD4 cell counts who were undergoing ART treatment, life expectancy was just a few years lower than that of the general public.

Key factors influencing life expectancy include CD4 count at treatment start, with higher CD4 levels linked to lower mortality risk (risk of death). Other risk factors that may affect a person’s life expectancy include:

• Their age, sex, and ethnicity
• What year they started treatment for HIV
• How they acquired HIV (e.g., through sex versus an injection)
• Their CD4 and CD8 levels one year after starting treatment
• Their viral load
• Other health conditions or complications that arise during ART

Comorbidities and HIV

Compared with the general population, people who have received an HIV diagnosis have an increased risk of developing certain comorbidities. A comorbidity is a disease or medical condition that occurs at the same time as another condition. As people age, they become more susceptible to age-related comorbidities that may reduce their quality of life. The following list highlights five types of health problems worth watching out for as you age with HIV.

1. Metabolic Syndrome and Cardiovascular Disease

Metabolic problems occur when the body is unable to break down and use proteins, fats, and carbohydrates. The prevalence of metabolic dysfunction that resembles metabolic syndrome is higher for people with HIV. Metabolic syndrome includes hypertriglyceridemia (high triglycerides, a type of fat, in the blood), low high-density lipoprotein cholesterol (the “good” type of cholesterol), and insulin resistance. These conditions predict an increased risk of cardiovascular disease, which is a term used to describe diseases that affect the heart or blood vessels.

One study looked at whether people aged 18 and older living with HIV had higher rates of comorbidities compared to people without HIV. The results showed that people with HIV were more likely to have chronic (long-term) conditions such as diabetes, high blood pressure, high cholesterol, and chronic kidney disease.

Stroke was also seen more often in people with HIV. However, the rates of myocardial infarction (heart attack) and coronary artery disease (buildup of plaque in the arteries supplying blood to the heart) were the same between the two groups.

Another study found similar results. Compared to those without HIV, people aged 50 or older with HIV were more likely to have chronic conditions such as diabetes, high blood pressure, stroke, lung diseases, and dementia. The researchers also noted a higher risk of cardiovascular disease.

2. Liver Disease

Another chronic health condition, liver disease, is among the leading causes of non-AIDS-related death in people with HIV. Coinfection with hepatitis B and hepatitis C viruses (HBV and HCV) is common in people with HIV — particularly among those who acquired HIV while using injectable drugs. For example, 5 percent to 25 percent of those with HIV may be coinfected with HBV, and 30 percent may have HCV. When a person has both HIV and HBV or HCV, there is a faster progression to scarring and permanent damage of the liver, resulting in long-term liver disease and risk of liver cancer. However, better treatments for hepatitis C are improving the outlook for people who have both HIV and HCV.

3. Cancers

Lymphoma (a type of cancer in the immune system) and cancers related to human papillomavirus (HPV) were also more likely to develop in people with HIV.

Types of cancers related to HPV — and the part of the body affected — include:

• Cervical — Cervix (the organ connecting the uterus and vagina)
• Vulvar — Vulva (external female genital organs such as the clitoris, vaginal lips, and opening of the vagina)
• Penile — Shaft or glans of the penis
• Anal — Anus (opening of the rectum, the last part of the large intestine, to the outside of the body)
• Oropharyngeal — Oropharynx (the part of the throat located at the back of the mouth, including the soft palate, base of the tongue, and tonsils)

The incidence (number of new cases) of liver and lung cancers is also higher in people with HIV. The increased rate of lung cancers is largely explained by high rates of cigarette smoking.

4. Age-Related Comorbidities

Not only do age-related comorbid conditions occur more often in people with HIV than in people without HIV, but they also develop at younger ages.

Osteoporosis is commonly seen in older age. This condition occurs when the bones become weak, causing them to break easily. Osteoporosis is common in people with HIV. Some types of ART therapy may also increase the risk of osteoporosis. Older adults are at a higher risk of falls as well, which is especially dangerous when coupled with the increased risk of osteoporosis and fractures.

Frailty, which is generally seen in the geriatric (older) population, commonly occurs at an earlier age in people with HIV. Symptoms include weakness, exhaustion, decreased physical activity, and weight loss. This condition is associated with negative health outcomes and multimorbidity (two or more co-occurring chronic conditions). Frail older adults are more likely to be admitted to the hospital and require long-term care.

Decreased mental function can also occur in the aging population, as well as in those with HIV. Individuals living with HIV-associated dementia, a severe form of dementia, show decreased attention and concentration, as well as slowed thinking and slow body movements. About one-third of people with HIV have at least a mild form of neurocognitive impairment.

5. COVID-19 and HIV

Recent research shows that people living with HIV who haven’t received a COVID-19 vaccine may have a slightly higher risk of dying from the coronavirus, compared to people who don’t have HIV and haven’t been vaccinated. Vaccinations have proved to significantly reduce the risk of severe illness or death from COVID-19 for people living with HIV, especially when their immune system maintains a CD4 count above 350.

Age is the main risk factor for COVID-19-related deaths. Prior to the availability of vaccines, people 80 and higher faced a risk of death at least 20 times higher than those between 50 and 59 years old. Despite the significant protection COVID-19 vaccines offer, older adults who are fully vaccinated still face greater risks compared to their younger vaccinated counterparts.

Additionally, studies show that people with HIV as well as other health conditions may face a greater risk of severe illness or death from COVID-19. These conditions include higher body weight, diabetes, and hypertension (high blood pressure).

Why Are People With HIV at Higher Risk?

People living with HIV are at a higher risk of developing comorbidities due to a variety of factors, including:

• Damaging effects of chronic HIV infection, especially if uncontrolled for many years
• Chronic suppression of the immune system
• Toxicity related to ART regimens, especially prolonged exposure to certain older therapies, which were associated with more side effects
• Potential coinfection (simultaneous infections by different viruses) due to overlapping risk factors, such as intravenous drug use
• Alcohol use, smoking, and drug use
• Low levels of physical activity and unhealthy diets
• Ethnicity and gender — For example, Black men have the highest rate of cardiovascular disease in the U.S.
• Lower socioeconomic status

Communicate With Your Health Care Team

Talk with your HIV care provider about preventing future comorbidities as you age with HIV. Continue taking your antiretroviral treatment, and keep your HIV controlled by having regular follow-up visits with your HIV care team.

Talk With Others Who Understand

On myHIVteam, the social network for people with HIV and their loved ones, more than 40,000 people come together to ask questions, give advice, and share their stories with others who understand life with HIV.

Are you an older adult living with HIV? Are you also living with a comorbidity such as heart disease or cancer? Share your experience in the comments below, or start a conversation by posting on your Activities page.