Maturity as an Advantage: Superior Immunologic and Virologic Control in Older People Living With Hiv in a Brazilian Cohort

The aging of the population living with HIV/AIDS is an increasing reality and poses new challenges to clinical practice. Understanding the demographic, immunologic, and therapeutic profiles of Older People Living with HIV (OPWH) is essential to optimize care strategies. This study, conducted in a national reference center, compared the clinical profiles and virologic outcomes of OPWH with those of People Living with HIV/AIDS (PLWH) under 50 years of age, also analyzing the antiretroviral therapy (ART) regimens used. This was a cross-sectional, observational cohort study including 1,020 PLWH on continuous ART between January 2021 and July 2023. Participants were divided into G1 (≥ 50 years; n = 576; 56.5%) and G2 (< 50 years; n = 444; 43.5%). Data collected included sex, ART duration (≥ 11 vs. < 11 years), current and nadir CD4⁺ T-cell counts (< 350 vs. ≥ 350 cells/mm³), and regimen type (TDF+3TC+DTG vs. dual therapy: 3TC+DTG or 3TC+DRV/r). Outcomes included viral suppression (< 40 copies/mL) and virologic failure (> 500 copies/mL). Comparisons were made using the chi-square test (p < 0.05). The cohort consisted of 1,020 participants, 66.4% of whom were men, with no significant difference between groups (G1: 67.9%). ART duration ≥ 11 years was more common among older adults (47.1% vs. 39.2%; p = 0.010). Only 7.0% of OPWH had CD4⁺ < 350 cells/mm³, compared with 13.3% in G2 (p = 0.0012). Simplified regimens were more frequently used by OPWH (37.8% vs. 28.3%; p = 0.003). Viral suppression rates were significantly higher in G1 (89.8% vs. 83.3%; p < 0.0001), and virologic failure was lower (2.5% vs. 10.1%; p < 0.0001). In real-world settings, Older People Living with HIV (OPWH) show longer therapeutic trajectories, better immunologic profiles, and higher viral suppression rates, with lower virologic failure compared to younger PLWH. These findings highlight the role of experience and sustained adherence in therapeutic success and emphasize the importance of personalized strategies for aging with HIV, recognizing maturity as an ally of treatment effectiveness.