Effectiveness of simplified ART regimens in older adults living with HIV: real-world evidence from a Brazilian cohort

Antiretroviral therapy (ART) has transformed HIV from a life-limiting infection into a manageable chronic condition, shifting attention toward the emerging challenges faced by the growing population of adults aged 50 years or older living with HIV. This observational cohort study tracked 1,018 individuals treated in the medical system in Brazil, a middle-income country, to better understand the effectiveness of traditional and simplified ART regimens in older adults living with HIV (OALH), a frequently underrepresented group in clinical studies. Older adults, those aged 50 and above, living with HIV achieved significantly higher rates of undetectable viral load (89.4 vs 83.2%, P<0.006) and fewer cases of virological failure, defined as HIV-RNA >500 copies/mL (2.5 vs 10.1%; P<0.0001) than younger adults aged 18-49, and demonstrated superior immune recovery through significantly greater CD4+ T-cell counts (P=0.0012). The multivariate analysis found that improved clinical outcomes (undetectable viral load) were most highly correlated with the simplified treatment regime and more years of treatment duration. These findings highlight the value of simplified ART regimens and sustained treatment duration, which were observed to be more frequent in OALH.