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

Winston, Alana,b; Underwood, Jonathana,b

Current Opinion in Infectious Diseases: February 2015 - Volume 28 - Issue 1 - p 17–22
doi: 10.1097/QCO.0000000000000117
HIV INFECTIONS AND AIDS: Edited by David Dockrell

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.

aSection of Infectious Diseases, Imperial College London

bDepartment of HIV and GU Medicine, St. Mary's Hospital, Imperial Healthcare NHS Trust, London, UK

Correspondence to Dr Alan Winston, Clinical Reader and Consultant Physician, Clinical Trials, Winston-Churchill Wing, St. Mary's Hospital, Praed Street, London W2 1NY, UK. Tel: +44 20 3312 1603; fax: +44 20 3312 6123; e-mail: a.winston@imperial.ac.uk

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