Trends in Age-Related Health Outcomes in People with HIV in Spain, 2006-2023

Background With antiretroviral therapy (ART), people living with HIV (PLHIV) live longer and face age-related health challenges. The long-term evolution of non-AIDS comorbidities in this population remains unclear. We assessed temporal trends in incidence and age at onset of major age-related outcomes in PLHIV. Methods We conducted a longitudinal study using CoRIS, a nationwide cohort of ART-naive PLHIV in Spain. Participants were grouped into three calendar periods (2006–2011, 2012–2017, 2018–2023). The primary outcome was serious non-AIDS events (SNAEs), including major cardiovascular events, non-AIDS malignancies, and non-AIDS deaths. Secondary outcomes were hypertension, diabetes, dyslipidemia, heart failure, fracture, chronic kidney disease, dementia, and polypharmacy. Incidence was analyzed with Kaplan–Meier and Cox models, age at onset with adjusted linear regression. Analyses were stratified by sex. Results Among 18,659 participants (55,133 person-years), 85% were male, median age 35 years. SNAE incidence declined (adjusted HR for 2018–2023 vs 2006–2011: 0.68, 95%CI 0.50–0.92), with delayed predicted age at first event (42.2 to 48.6 years, p<0.001). Secondary comorbidity incidence was largely stable, while polypharmacy rose, especially in older adults and women. Women showed smaller reductions in SNAE incidence (from 9.3 to 6.5 per 1,000 person-years vs. 13.0 to 6.4 per 1,000 person-years in men) and higher rates of hypertension and diabetes. Conclusion In Spain, serious age-related outcomes among PLHIV have declined with delayed onset, consistent with improvements in HIV management and prevention of comorbidities. However, persistent comorbidity burden and rising polypharmacy—particularly among women—highlight the need for targeted strategies.