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Lancet Report Recommends Paradigm Shift in Care for Older Adults with HIV
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Expanding care beyond essential antiviral therapy will help support growing older population with HIV expected to reach 20.2 million worldwide by 2040
July 27 2026
A new report by a group of HIV researchers in the journal Lancet HIV recommends that health systems caring for older individuals with HIV should move beyond the standard antiretroviral therapy to a more comprehensive, healthy-aging approach. The report was led by researchers at the Johns Hopkins Bloomberg School of Public Health and Yale School of Medicine, with colleagues at more than 40 institutions and nine persons living with HIV.
In their report, commissioned by the editors of the journal Lancet HIV, the authors recommend a broad set of health-system changes to manage the distinct challenges involved in HIV prevention and screening, treatment, and long-term care in this older population.
Recommendations include monitoring physiological age and functional declines, minimizing the multi-pharmaceutical use common among older adults, and promoting mental health and a healthy lifestyle—all while maintaining adherence to antiretroviral therapy.
"People older than 50 living with HIV tend to have a physiologic age that is greater than their chronological age due to their chronic infection," says study joint first author Keri Althoff, PhD, MPH, a professor in the Bloomberg School's Department of Epidemiology. "The increase in this population is a big challenge for healthcare systems around the world and will continue to grow. We need to act now."
The report also recommends HIV prevention and screening services that are more targeted to older adults, tailored to reduce stigma and ageism and meet this population's special needs and vulnerabilities, including casual partners and changes in income.
"Even integrated health networks often consist of multiple vertical services, each with separate forms, schedules, and out-of-pocket expenses," Althoff says. "To provide appropriate care and support for healthy aging with HIV, we must change the care structure and link persons with HIV to community organizations and digital tools outside of the clinic walls."
Better integration of existing HIV care programs into broader chronic disease management, and innovations in HIV care programs that incorporate broader geriatric care, could both help solve this looming problem. The report concludes by emphasizing the importance of linking patients to community-based organizations and digital tools to ensure care is a partnership among patients, providers, and the community.
https://publichealth.jhu.edu/2026/lancet-report-recommends-paradigm-shift-in-care-for-older-adults-with-hiv
The Lancet HIV Commission on ageing and HIV: a global perspective, comments
Download the PDF here
Download the PDF here
Download the PDF here
July 2026
Amy C Justice*, Keri N Althoff*, et al.
Geriatric syndromes such as frailty and falling, which do not have simple organ-based explanations, have greater impacts on quality of life for people with HIV.7
Caregivers can be trained to assess the care recipient's level of function, promote home safety awareness, and recognise when changes occur.
The mental health needs of older people with HIV require the substantial provision of health-care and social services
People ageing with HIV are at increased risk of acute and chronic kidney disease.
Compared with age-matched people without HIV, older people with HIV face higher rates of cardiovascular
disease, including myocardial infarction, heart failure, thrombotic stroke, and sudden cardiac death.203 Weight
gain after ART initiation, resultant diabetes, dyslipidaemia, and hypertension all contribute to metabolic syndrome, which increases the risk of cardiovascular disease. Smoking, alcohol, and cocaine use also increase risk, as does anaemia and depression.203,208,20
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