There is considerable complexity around comorbidities and their relationship to ageing, particularly in the areas of cardiovascular disease, osteoporosis, menopause and dementia. This is an area where there is significant emerging knowledge.
Where possible the involvement of a geriatrician with HIV knowledge will strengthen service provision for this population. This may be achieved through co-specialty clinics, mentoring schemes or identified experts for the provision of advice and guidance.
There may be more need for multidisciplinary services involving other specialties and primary care to reduce the number of clinic visits and lessen potential for harm, such as HIV pharmacists, older age pharmacists, physiotherapy and occupational therapy. Supplementary tailored health programmes, for example around exercise, may be of increased importance for this population.
In direct clinical terms, attention needs to be paid to drug–drug interactions as we learn more about the possible co-effects of HIV medications and medications used in ageingrelated health conditions. It may be important to tailor ART to co-medications including menopause hormone therapy where possible. There may be a need to actively encourage early ART uptake among those diagnosed with HIV in older age, as this may be crucial in reducing morbidity and mortality.
Among those living long term and ageing with HIV, there is a need to recognise that long and complex treatment history may have significant consequences for both health and well-being. In particular, the experience of suboptimal treatment may be implicated in both higher levels of treatment optimism and treatment scepticism. Concerns about remaining treatment options may have implications for treatment switching.
In addition, consideration should be made for the use of designated care coordinators where possible for those experiencing complex care issues, particularly where care is across multiple health and social care service provision.