Antiretroviral Guidelines

US DHHS Guidelines with Australian commentary


HIV and the Older Patient


Last Updated: January 28, 2016; Last Reviewed: January 28, 2016

Key Considerations When Caring for Older Patients With HIV

AU comment: Cardiovascular risk calculators

AU comment: Abacavir and D:A:D

Key Considerations When Caring for Older Patients With HIV


  • Antiretroviral therapy (ART) is recommended for all patients regardless of CD4 T lymphocyte cell count (AI). ART is especially important for older patients because they have a greater risk of serious non-AIDS complications and potentially a blunted immunologic response to ART.
  • Adverse drug events from ART and concomitant drugs may occur more frequently in older patients living with HIV than in younger patients with HIV. Therefore, the bone, kidney, metabolic, cardiovascular, and liver health of older patients should be monitored closely.
  • Polypharmacy is common in older patients with HIV; therefore, there is a greater risk of drug-drug interactions between antiretroviral drugs and concomitant medications. Potential for drug-drug interactions should be assessed regularly, especially when starting or switching ART and concomitant medications.
  • HIV experts, primary care providers, and other specialists should work together to optimize the medical care of older patients with HIV with complex comorbidities.
  • Early diagnosis of HIV and counseling to prevent secondary transmission of HIV remains an important aspect of the care of the older patient with HIV.
Rating of Recommendations:  A = Strong; B = Moderate; C = Optional
Rating of Evidence:  I = Data from randomized controlled trials; II = Data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion