Cardiovascular disease (CVD) is among the major non-AIDS morbidities successfully treated HIV-positive patients are now experiencing. It is suggested that CVD occurs earlier among HIV-positive patients compared to HIV-negative patients, and at a higher rate. The risk of CVD in HIV-positive patients is more complex than in the general population with potential interactions between traditional cardiovascular risk factors, genetics, family history, the effect of ART, and HIV infection itself.

Emerging evidence suggest that large artery stiffness and vascular aging are accelerated in HIV infection.

This review highlights the different forms of kidney disease in HIV-positive patients. Chronic kidney disease is an important risk factor for and marker of cardiovascular disease and, in the context of ageing HIV cohorts, of increasing importance. HIV-positive patients should be screened for kidney disease to allow clinicians to manage risk factors and institute appropriate therapy. HIV medications may need to be dose-adjusted in patients with kidney disease.

With many parts of the world seeing an aging cohort of people living with HIV sexual functioning may be adversely affected. Many people living with HIV wish to remain sexually active as they age but they may be at increased risk of sexual dysfunction and this may be impacted by antiviral therapy. Effective treatments for sexual dysfunction are available but may also be affected by antiviral therapy.

Little has been published on the effects of aging on sexually transmissible infection (STI) acquisition among people living with HIV. The available literature is reviewed and contrasted with data from older individuals in the general population and older populations at higher risk of HIV. Although there is no evidence of a consistent effect of age on STI rates, older HIV positive gay men appear to be at higher risk of acquiring several STI.

The use of highly active antiretroviral therapy (HAART) has led to a marked reduction in AIDS-associated mortality. Consequently, the HIV-infected population is aging and liver disease has emerged as a leading cause of morbidity and mortality. This article, reviews the current knowledge of the impact of aging, HIV infection and HAART on liver disease. Areas for further research are also discussed.

People with HIV are at increased risk of a wide range of mainly infection-related cancers. However, the pattern of excess cancer incidence is not consistent with accelerated aging. Reduction of cancer risk in people with HIV can be achieved through maintenance of HIV suppression, close to normal immune function, and by assessing and reversing lifestyle cancer risks such as tobacco and alcohol exposure.

Effective long-term treatment has increased life expectancy in the HIV-positive population and subsequently led to increases in many complications including cardiovascular and neurological complications, kidney and liver dysfunction, and metabolic complications that are contributed to by HIV infection, antiretroviral therapy and advancing age. The increase in older HIV infected individuals has not been accompanied by appropriate treatment guidelines or recommendations for antiretroviral therapy or clinical management in these patients.

There are currently no estimates of the future burden of HIV-associated dementia (HAD) in Australia. Using mathematical modelling and HAD prevalence data obtained from a large Sydney metropolitan hospital we show that the number of HIV-infected older men and women and those living with HAD will increase substantially by the year 2030. The annual cost of care for these individuals will almost double over this period.

Using a sample of almost 1000 New York City HIV-positive persons aged 50 years and older significant correlations were found between depressive symptoms (mental health burden) and the number of comorbidities (disease burden) as well as with specific conditions, i.e., sensory loss, dermatological problems, heart and respiratory conditions and fractures. Multimorbidity management is needed for this vulnerable population, with mental health issues given priority to achieve optimal health outcomes.