The last decade has seen a dramatic change in the characteristics of the population of people living with HIV in most settings. The majority of people living with HIV who are aware of their diagnosis are now started on combination antiretroviral treatment – in most cases, people experience a good response to treatment, and their immune systems are able to recover. As a consequence, we have seen dramatic improvements in the life expectancy of people living with HIV. As a result of this (as well as the continued new diagnoses of people who are either infected or tested for the first time in their 50’s and older) the average age of people attending HIV clinics has increased. We expect this trend to continue into the future.
As the group of people living with HIV has aged, so the spectrum and burden of age-associated co-morbidities (e.g. heart, liver and kidney disease and cancers) has increased. This means that people living with HIV are likely to require increased healthcare at least for the foreseeable future.
Whilst there is some limited evidence to suggest that people living with HIV may experience some of these co-morbidities at an earlier age than their HIV-negative counterparts, the evidence that we have to date is not strong enough to show conclusively that HIV infection is to blame. The results from well-designed studies with appropriately matched control groups, such as POPPY, will provide the robust evidence that is needed to allow us to confirm whether HIV does play an independent role in the development of these co-morbidities.
Regardless of the impact of HIV itself, it is also becoming apparent that other, non-HIV factors (e.g. smoking, alcohol use, recreational drugs) may also play a role in the development of many of these co-morbidities. Cohorts such as POPPY will help us to identify the factors that should be targeted in order to reduce the risk of these co-morbidities in the future.