Emerging concepts on the use of antiretroviral therapy in older adults living with HIV infection

PURPOSE OF REVIEW: With the overwhelming success of combination antiretroviral therapy, HIV infection is now a chronic, but manageable, medical condition. Consequently, HIV-infected cohorts are ageing leading to new challenges in the life-long management of this condition. Here, we review recent data concerning the modern treatment of older HIV-infected adults. RECENT FINDINGS: HIV-infected cohorts are ageing with the majority of those infected predicted to be more than 50 years old within the next 2 decades. There is emerging evidence of increased antiretroviral drug exposure in older individuals, but the evidence this leads to increased toxicity is less clear-cut. In addition, the choice of antiretroviral agents is more challenging in older HIV-infected patients because of the presence of comorbidities, which occur more commonly and at a younger age than in HIV-uninfected individuals and because of a higher propensity for drug-drug interactions due to the use of concomitant medications. Specific recommendations regarding antiretroviral treatment of older HIV-infected individuals are lacking and prospective trials in older age groups are urgently needed. SUMMARY: The use of antiretroviral therapies in older individuals is complex. Development of novel antiretrovirals and antiretroviral combinations with a low propensity for toxicity, drug-drug interactions and reliable pharmacology regardless of age is urgently needed.